The Daily Briefing

News for Health Care Executives

Nine hospitals win award for community health programs

August 12, 2011

Hospitals & Health Networks this month profiled the winners of the American Hospital Association's (AHA) NOVA Awards, highlighting the various ways that the hospitals are working with community partners to improve care.
 
AHA's NOVA Awards, which are sponsored by Hospitals & Health Networks, recognize member hospitals and health systems that effectively and collaboratively improve community health through health care, economic, or social initiatives. The awards were presented at the AHA-Health Forum Leadership Summit in San Diego in July. 
 

The Diabetes Collaborative (Chicago)

In 2006, Northwestern Memorial Hospital, Northwestern University's Feinberg School of Medicine, and two federally qualified health centers joined to form the Diabetes Collaborative, which aims to improve diabetes care among residents of two underserved and uninsured Chicago neighborhoods. The collaborative identifies Type 2 diabetes patients and teaches them how to manage the disease. It provides patients with "prescriptions" to buy healthy food items at Walgreens stores, distributes bilingual materials to help patients better understand their condition, and deploys chronic care teams. Over five years, program participants saw significant improvement across eight key care quality measures. 
 

The ED Consistent Care Program (Olympia, Wash.)

In 2003, Providence St. Peter Hospital launched the ED Consistent Care program after observing a growing drug and substance abuse problem among ED patients with chronic conditions. In collaboration with the CHOICE Regional Health Network, a coalition of health providers, Providence St. Peter coordinates patient care and provides participants with care plans that may include enrollment in a community health care or dependency program. After seven years, ED visits from program participants have dropped by 50%, saving Providence St. Peter an average of $9,000 per patient annually, or about $5.6 million cumulatively. 
 

Integrated Community Nursing Program (Fort Wayne, Ind.)

The Parkview Health Integrated Community Nursing Program works with a variety of community agencies to provide low-income and underserved patients with the resources required to meet their health needs. With 14 nurses on staff, the program offers health screenings, immunizations, referrals, home visits, follow-ups, and medical home connections. It also helps patients manage a variety of conditions, such as asthma and diabetes. In the program's first year, there were 38 fewer asthma-related ED visits and nine fewer hospitalizations, resulting in $605,980 in total savings. 
 

Milwaukee Health Care Partnership

In 2006, Aurora Health Care, Children's Hospital & Health System, Columbia St. Mary's, Froedtert Health, and Wheaton Franciscan Healthcare partnered to expand coverage to the region's most vulnerable residents. The public-private consortium coordinates efforts throughout the county to provide and improve care for low-income residents. For example, the program connects ED patients to federally qualified health centers and subsidizes case-management resources. The program has helped increase ED referrals to medical homes from 78 in the first month to 550 monthly.
 

Rochester Youth Violence Partnership (N.Y.)

The University of Rochester Medical Center (URMC) launched an in-hospital violence intervention program to protect teenagers who present in its trauma center with gunshot and knife wounds from further injuries. URMC now performs a social-work assessment on injured teens to identify risk factors that caused the injury and create a safe discharge plan with follow-up services. In 2007, nine previously injured teens returned to the trauma center as a result of violence. Since then, no injured teens have returned (Szabo, Hospitals & Health Networks, August 2011).

Miami is top metro area for ED patient satisfaction, report finds

August 12, 2011

1. Hospital ED patient satisfaction is highest in Miami, Hartford, Conn., and Indianapolis, according to an annual ED patient satisfaction report.
    
   The Press Ganey survey analyzed data for more than 1.6 million patients treated at 1,908 hospitals nationwide between Jan. 1 and Dec. 31, 2010, to gauge their satisfaction with treatment received in the ED. Based on the findings, Press Ganey determined that the top 10 major metropolitan areas—which had a population of at least one million residents—include:
    
   1. Miami-Ft. Lauderdale;
   2. Hartford, Conn.;
   3. Indianapolis;
   4. Columbus, Ohio;
   5. Milwaukee;
   6. New Orleans;
   7. Boston;
   8. Philadelphia;
   9. Detroit; and
   10. Chicago.
    
   Press Ganey also identified the top 10 smaller metro areas—which had a population of fewer than one million residents—for ED patient satisfaction. They include:
    
   1. Wichita, Kan.;
   2. Madison, Wis.;
   3. Grand Rapids, Mich.;
   4. Greenville, S.C.;
   5. Honolulu, Hawaii;
   6. Allentown-Bethlehem, Pa.;
   7. Dayton, Ohio;
   8. Toledo, Ohio;
   9. Stamford-Norwalk, Conn.; and
   10. Baton Rouge, La.
    
   The survey findings revealed that patients place a premium on being kept informed about ED delays. "[G]ood communication helps [patients] understand the processes within the ED environment and shows them that staff has not forgotten them," the company's vice president of hospital services said. She noted that hospitals should examine and adapt patient flow to avoid overcrowding and increase satisfaction.
    
   According to Healthcare Finance News, the report also suggested that ED patient satisfaction is directly correlated to a hospital's bottom line. "When you look at patient flow, patients who left without being seen or without being treated for whatever reason, usually because of the wait, have a financial impact on a hospital," Press Ganey's senior vice president for clinical and operational consulting services said (Letourneau, Healthcare Finance News, 8/10; Press Ganey release, 8/10).
   

HHS, Treasury propose rules on health insurance exchanges

August 12, 2011

HHS and the Department of Treasury on Friday issued proposed rules outlining eligibility and tax credits for state-based health insurance exchanges created under the federal health reform law.

According to an HHS release, the three draft rules focus on:

• Access to coverage for consumers and small businesses: The rules will allow consumers to enroll in high-quality health plans and receive financial assistance for coverage through tax credits and cost-sharing programs. Small business will be able to offer multiple health plan options to their employees and also be eligible for tax credits. 

• Health insurance premium tax credit: Individuals and families will be able to obtain tax credits to offset insurance costs, which HHS expects will help expand health coverage to include millions of U.S. residents.

• Medicaid eligibility: Exchange enrollment will be coordinated with Medicaid and the Children's Health Insurance Program to streamline processes and lower states' administrative burden.

The administration within the next several weeks is expected to launch an outreach campaign to solicit public comments on the draft rules from employers, consumers, state leaders, health care providers, and insurers. In addition to accepting comments for the next 75 days, the agencies also will be holding public forums in Atlanta, Chicago, Denver, New York City, Portland, and Sacramento.

HHS on Friday also awarded $185 million to 13 states and the District of Columbia to help them build exchanges. According to HHS, more than half of states already have started implementing exchange programs. HHS Secretary Kathleen Sebelius on Friday also sent a letter to governors describing resources and options available to assist states in instituting the program (HHS release, 8/12).

Study: CT scans in EDs soar while admissions drop

August 12, 2011

ED patients are undergoing CT scans about four times more frequently than patients in the mid-1990s, according to a study in the Annals of Emergency Medicine.
 
For the study, University of Michigan Health System researchers and colleagues examined data from the National Hospital Ambulatory Medical Care Survey for 368,680 ED visits at 601 hospitals from 1996 to 2007. The study found that the use of CTs in the ED jumped from 3.2% of all admissions in 1996 to 13.9% of all admissions in 2007.
 
The largest jump in CT scans was for older patients, the study found. In 1996, about 9.1% of patients over age 79 had a scan in the ED, compared to about 29.1% in 2007. CT scan rates increased most for abdominal pain, chest pain, flank pain, and shortness of breath, according to the findings. Meanwhile, the hospitalization rate for patients who underwent a CT scan fell from 26% in 1996 to about 12% in 2007, while the overall hospitalization rate for ED patients rose from 11% to 13% during that time period.
 
The researchers say several factors may have contributed to the growth in CT scan use in EDs, including greater diagnostic accuracy, reimbursement updates, and defensive medicine. The American College of Emergency Physicians defended the increase, noting that the test has helped reduce hospitalizations, Kaiser Health News' "Capsules" reports.
 
In an accompanying editorial, a University of Florida Health Science Center physician says reducing CT scan use may be difficult because imaging "is not an entirely objective question that can be neatly resolved by empirical data and formal analysis." Instead, he argues that it is "a tangled, socially constructed issue involving competing views of risk, benefit, and obligation, and the elusive question of how much certainty we must have" (CMIO, 8/10; Nafziger, DOTmed News, 8/10; Galewitz, "Capsules," KHN, 8/10).

Report: States cutting reimbursement for CHIP, Medicaid in 2011

August 12, 2011

The majority of changes by states to Medicaid and CHIP have reduced benefits or reimbursement rates, according to a report by the National Association of Children's Hospitals and Related Institutions (NACHRI).

The report found that:

• Ten states enacted laws to lower reimbursement rates for inpatient, outpatient, or physician services, while just four states increased rates for at least one type of service;

• Seven states passed laws to limit benefits or increase cost sharing, while three improved patient benefits or lowered copayments;

• Four states have made other changes to benefits or cost sharing, including a pilot program in Utah that requires Medicaid beneficiaries to do community service; and 

• Nine states tightened eligibility requirements that NACHRI says will restrict children's access to coverage—by passing laws to lower qualifying income levels or adding new requirements that applicants must fulfill before enrolling—while six states passed laws to expand coverage for children or adults, or make enrollment easier (Adams, CQ HealthBeat, 8/10 [subscription required]; Baker, "Healthwatch," The Hill, 8/10).
  

Meaningful use driving hospitals to adopt order entry systems

August 12, 2011

The meaningful use program has significantly boosted adoption of computerized physician order entry (CPOE) systems, according to a report from research firm KLAS.
 
For the report—titled, "CPOE 2011: The ARRA Effect"—researchers collected data from nearly every U.S. hospital that implemented a CPOE system in 2009 and 2010. According to the report, an average of 87 hospitals annually implemented a CPOE system before the meaningful use program. The average has jumped to 233 hospitals annually. About 21.7% of hospitals had CPOE systems in 2010, an increase from the 15.7% of hospitals that had the systems in 2009 and 12.5% in 2008.
 
However, nearly 80% of hospitals still lacked CPOE systems last year, the report found. According to Government Health IT, CPOE implementation remains a hurdle for hospitals seeking to demonstrate meaningful use by the end of 2012. Under Stage 1 of the meaningful use program, health care providers must use CPOE systems to order at least one medication for 30% of unique patients. The use of CPOE could expand under future stages of meaningful use.
 
One of the report's authors notes that more hospitals and clinics are choosing CPOE systems as deadlines approach under Stage 1 (Goedert, Health Data Management, 8/9; Mosquera, Government Health IT, 8/11).

Can you 'catch' weight gain from your friends?

Experts wrestle over answer

August 12, 2011

Experts are criticizing highly publicized research studies that found that social behaviors—like obesity, smoking, and loneliness—can be contagious among friends, arguing that the studies' methods and conclusions are unsound, the New York Times reports.
 
Across the past several years, studies from Harvard University and University of California-San Diego researchers have found that individuals can pass social behaviors from person to person. According to the researchers, the findings suggested that it was possible to limit unwanted behavior by focusing public health efforts on small groups of friends, who then would influence their social networks.
 
For example, the first study that suggested that obesity could be contagious was published in NEJM in 2007. For the study, the researchers analyzed data for 12,067 individuals and found that friends and friends of friends had similar levels of obesity. The authors theorized that people's idea of an acceptable weight changes when they observe their friends' weight.
 
However, critics contend that the researchers discounted the effect of shared environments or homophily—the tendency to choose friends like oneself—on the subjects. "It is very hard to be sure you have properly accounted for all the confounding variables in the observational study," a Georgetown University social scientist said. Meanwhile, Carnegie Mellon University statisticians have argued that it is mathematically impossible to use observational data to determine that a contagion is why behaviors spread.
 
The study authors say they are aware of their studies' limitations but argue that their conclusions are robust. "This is how science proceeds," one author said, adding, "We published our data. We said, 'Look, we think this is important. You should help us figure out how to do this better'" (Kolata, Times, 8/8).

Red Cross: Stop attacking hospitals, health workers

August 12, 2011

The International Committee of the Red Cross (ICRC) on Wednesday called for an end to deadly attacks on hospitals, physicians, and medical staff, who have become targets in conflicts and wars worldwide.

A recent ICRC report found that 655 violent incidents disrupted health care delivery in 16 countries from 2008 to the beginning of 2011.

During those incidents, 128 medical personnel were kidnapped, 159 health care workers were killed or injured, and 32 ambulances were damaged (Nebehay, Reuters, 8/10; AP/Google News, 8/10). 

Daily roundup: August 12, 2011

August 12, 2011

• Arizona: A judge on Wednesday ruled that the state may deny no-cost health care to about 135,00 low-income residents across the next year, the Arizona Daily Star reports. A 2000 voter mandate prohibits the state legislature from denying health care for individuals below the federal poverty level. However, the judge said the act did not preclude lawmakers from refusing to fully fund the state's Medicaid program, which would allow Gov. Jan Brewer (R) to lower eligibility. Brewer says the state's financial situation made it necessary to limit eligibility and turn patients away. However, state Rep. Steve Farley (D) notes that the decision "will flood our emergency rooms" with people seeking care (Fischer, Daily Star, 8/11).

• California: The state's health care providers increasingly are focusing on ways to manage patients' chronic health conditions by using team-based initiatives to engage patients in their own health, HealthyCal reports. For example, the "Team Up for Health" pilot program sponsored by the California HealthCare Foundation aims to link patients and their health care advocates with physician teams, while expanding the number of medical personnel who see patients and the time spent with patients. Meanwhile, since 2008, the state Department of Managed Health Care has been combating diabetes and heart disease with its Right Care Initiative. This effort encourages physicians to prescribe effective drugs to help control the symptoms of 70% of patients with heart disease, high blood pressure, and diabetes (Perry, HealthyCal, 8/10).

• Iowa: Gov. Terry Branstad (R) on Wednesday launched the "Healthiest State Initiative," an effort to turn Iowa into the nation's healthiest state by 2016, the AP/Omaha World-Herald reports. Using $25 million from Wellmark Blue Cross and Blue Shield, the initiative will focus on 10 cities across five years. According to a project co-director, participating cities likely will make efforts to become more walkable, add bike lanes, provide cooking classes, and reach out to schools and businesses. Branstad expects the program to save the state up to $16 billion in five years through increased productivity and lower health care costs (AP/World-Herald, 8/10).

• Massachusetts: Partners HealthCare System has signed a letter of intent to take over Neighborhood Health Plan, a Boston-based health company that primarily insures low-income state residents, the Boston Globe reports. Although no money would be exchanged under the deal, Partners would provide grants to more than 50 Neighborhood Health Plan-affiliated community health centers and work with them to make care more efficient (Weisman/Kowalczyk, Globe, 8/11).