Hitting the metric but missing the point
September 07, 2011
Mike Wagner, the Advisory Board's chief teaching officer, discusses why organizations that manage improvement efforts solely according to key performance indicators (KPIs) are likely to constantly struggle to maintain high performance.
Avoid the three common pitfalls that plague executives and learn why hitting standard KPIs shouldn’t be your primary goal. Watch now.
Medical monitoring goes mobile
Temporary tattoos free patients from wires and monitors
September 07, 2011
The New York Times this week examined the growing "mHealth" field, noting that minuscule devices similar to press-on tattoos could help rein in health spending.
The mHealth trend uses mobile technologies, such as smartphone applications and wireless sensors, to educate, monitor, and treat patients. According to the Times, tattoos and other "epidermal electronics" may allow physicians to monitor patients from any location.
For example, University of Illinois at Urbana-Champaign researchers have developed an ultrathin tattoo device that weighs only three-thousandths of an ounce. Meanwhile, FDA last year approved a telemetry system that uses a 2-inch by 6-inch monitoring patch that transmits electrocardiogram readings to a central data center.
"Sensors on everyone, including a 60-year-old watching a football game who doesn't know he's at risk for a heart attack, would greatly reduce the changes of a fatal attack," Leslie Saxon, a University of Southern California cardiologist says.
Monitoring patients at home could significantly curb health care costs, the Times reports. For example a 2008 Department of Veterans Affairs study found that patients who used at-home biometric monitoring devices experienced a 19% drop in hospitalizations compared to when they were not participating in the program. According to the findings, the average patient cost $1,600 annually, which was much lower than the $13,121 the department spent to provide home-based primary care without the devices.
Despite mHealth's potential benefits, Chuck Parker, the executive director of Continua Health Alliance says only 50,000 to 70,000 U.S. patients currently are being monitored by such devices. He notes that additional financial incentives might encourage more hospitals to adopt the technology (Stross, Times, 9/3).
Gap in the rankings?
Children’s hospital rankings based on unreliable statistic, study finds
September 07, 2011
Mortality rates at children's hospitals, a key component in many popular commercial rankings, may be statistically unreliable, according to a study in Pediatrics.
As the U.S. health care system sharpens its focus on care quality, hospital mortality rates have become an increasingly common measure of performance and an important metric in major commercial rankings, such as U.S. News & World Report's 'Best Hospitals' list. However, critics warn that focusing on mortality rates may cause facilities to prioritize numbers over patient care.
To assess the accuracy of rates used in hospital rankings, Children's Hospital of Philadelphia researchers and colleagues analyzed more than 475,000 patients discharged in 2008 from 42 children's hospitals. The researchers ranked the hospitals using each facility's adjusted death rate, a measure that accounts for variations in local patient populations.
They found that 22 of the 42 possible ranking slots had overlapping confidence intervals for mortality rates, suggesting that there was no way to statistically determine if the rates actually were different. As a result a children's hospital ranked number 15 might also be ranked number 37, Reuters notes.
Although the study's lead author says it is unlikely that patients are harmed by selecting highly ranked hospitals, he says that patients "have to be aware that if the rankings are not that different they should be allowed to think about other things," such as "how close it is to home, will my family be able to visit me?"
According to U.S. News' Health Rankings editor, mortality rates are only "one of many key factors" considered in the rankings. He calls the study overly broad and suggests that researchers should focus only on the sickest patients, who can be more indicative of care quality (Joelving, Reuters, 9/6).
Massachusetts may cut payments to most expensive hospitals
September 07, 2011
Massachusetts House Majority Leader Ronald Mariano (D) on Tuesday proposed legislation that would require insurers to reduce payments to the state's most expensive hospitals and physicians, the AP/Boston Herald reports.
Since the state enacted health reforms in 2006, Massachusetts has been a model for the national health care overhaul. However, a report issued this summer by state Attorney General Martha Coakley (D) found that providers with market leverage because of location or reputation continue to charge up to twice as much as other providers despite the introduction of global payment models intended to control costs.
Mariano's proposal prohibits expensive providers from signing or renewing insurer contracts until their rates are lowered to below the 80th percentile of insurance plan rates. The bill also would require insurance plans to increase reimbursement rates for the state's lowest-paid hospitals to above the 20th percentile. The bill takes geographic factors into account by dividing Massachusetts into four separate rate quadrants. According to Mariano, the plan would save at least $267 million and address "a wide discrepancy between the 'have' hospitals and the 'have-not' hospitals."
Responding to the proposal, Massachusetts Hospital Association President Lynn Nicholas acknowledged that a price disparity exists between Massachusetts hospitals but that it was not wide enough to merit government intervention. She warned that "[l]owering existing payments to some hospitals could have very serious unintended consequences," adding that hospitals "could be forced to raise the price of their existing services or eliminate valuable but undercompensated services."
If passed, the law would go into effect on Jan. 1, 2012, and remain in effect until Dec. 31, 2015, when state reform provisions intended to change the health care payment system are fully implemented (Kowalczyk, Boston Globe, 9/6; AP/Herald, 9/6; Donnelly, Boston Business Journal, 9/6).
Protecting LGBT patients
CMS tells inspectors to enforce same-sex rights
September 07, 2011
CMS on Wednesday offered guidance to state agencies that conduct on-site inspections of hospitals, reminding the agencies to enforce protections for lesbian, gay, bisexual and transgender patients.
The agency in November issued a final rule that updated hospitals' Conditions of Participation in Medicare and Medicaid. Under the rule, hospitals that participate in the government programs must explain to all patients:
- That patients have a right to choose who can visit them during their stay;
- That these visitors can include family members, spouses, domestic partners, or another type of visitor; and
- That patients can designate a person of his or her choosing to make decisions on the patient's behalf.
According to HHS Secretary Kathleen Sebelius,"Couples take a vow to be with each other in sickness and in health and it is unacceptable that, in the past, some same-sex partners were denied the right to visit their loved ones in times of need." Sebelius and CMS Administrator Don Berwick stressed that the new guidance will help protect the rights of LGBT patients.
Separately, HHS' Health Resources and Services Administration on Wednesday announced a $248,000 grant to Boston's Fenway Institute for a national training center to help community health centers serve LGBT patients (CMS release, 9/7).
Primary health care
How GOP presidential candidates are approaching reform
September 07, 2011
Although three leading GOP presidential candidates have promised to repeal the federal health reform law, the pledge obscures their divergent health policy records while serving as state governors, the New York Times reports.
According to the Times, Texas Gov. Rick Perry, former Massachusetts Gov. Mitt Romney, and former Utah Gov. Jon Huntsman all have attempted to distance themselves from their own health care records by ramping up their opposition to the overhaul.
Romney avoids federal overhaul comparisons
Romney—who frequently criticizes the reform law for being a "one-size-fits-all" solution for states—has denied comparisons between the 2006 Massachusetts health law and the federal law. He notes that the Massachusetts law would be "one of my biggest assets" in a campaign debate against President Obama. However, according to a Massachusetts Institute of Technology economist, the Massachusetts law "has succeeded spectacularly," but "Romney never explains why it wouldn't work elsewhere. There is no reason it wouldn't work elsewhere."
Perry touts market solutions
Perry leads a state where 26% of residents were uninsured between 2008 and 2009, more than any other state. However, he "believes that expanding government-sponsored insurance is not the answer ... nor is requiring people to purchase it," a spokesperson for Perry said. Instead, she notes that "[h]e looks to free market solutions."
Perry has called for creating multistate compacts to let states opt out of federal health programs but receive federal funding to run substitute programs and implement malpractice restrictions, CQ Weekly reports. However, the Times notes that Texas has accepted almost $20 million in grants authorized by the overhaul, including $1 million to plan the state's health insurance exchange.
Huntsman remains quiet about former individual mandate support
In 2007, Huntsman sought to halve the number of uninsured Utah residents by 2010 and hired John Nielsen, a former hospital system lawyer, to facilitate that goal, the Times reports. According to Nielsen, Huntsman wanted to investigate whether the state "could replicate what Massachusetts had done." In 2008, Utah enacted a plan that relied on an exchange and an individual mandate, which Huntsman called necessary "if you're going to get it done and get it done right."
In his presidential campaign, Huntsman has remained quiet about his former support of an insurance mandate, the Times reports. Meanwhile, he said last month that he would support "a free-market approach to health care reform instead of a heavy handed Obama-like mandate" (Sack, Times, 9/3; Page, USA Today, 9/5; Kenen, CQ Weekly, 9/5 [subscription required]).
Stronger stroke standards
Medical group tightens stroke center guidelines
September 07, 2011
The Brain Attack Coalition (BAC) has released new guidelines that address standards of care for acute stroke patients in primary stroke centers (PSCs).
A special report detailing the recommendations was published online Aug. 25 and will appear in the September issue of Stroke. There currently are more than 800 PSCs certified by the Joint Commission and several hundred more that have been certified by the Healthcare Facilities Accreditation Program and various state agencies.
The updated recommendations take into account a decade's worth of changes in the diagnosis and treatment of stroke patients. Studies since the last set of BAC recommendations in March 2000 have confirmed that stroke units reduce mortality and length of stay and increase functional independence compared to general wards.
In addition, the authors "beefed up" imaging recommendations, Medscape Medical News reports. For example, BAC recommends that PSCs perform a CT scan within 25 minutes, or an MRI if the facility can administer it within the same time frame.
BAC also recommends that:
- Acute stroke teams have at least one physician and one other staff member available at all times;
- Neurosurgical services be available within two hours of when they are deemed clinically necessary;
- Stroke units have a telemetry system for monitoring blood pressure, pulse, and oxygenation, and an established monitoring protocol;
- PSCs have cardiac imaging equipment, such as a cardiac MRI, or a transthoracic or transesophageal echo; and
- PSCs evaluate and initiate early rehabilitation services such as speech, physical, and occupational therapy.
According to the lead author of the report, "Many hospitals have benefited and will continue to benefit from certification as primary stroke centers." He notes that "[e]ven more importantly, the patients cared for at PSCs have clearly benefited by getting better treatment, experiencing fewer complications, and going home from the hospital sooner" (Jeffrey, Medscape Medical News, 8/30; National Institutes of Health release, 8/25).
BP higher in ED than with PCP
Hypertension more common in EDs than physician's offices
September 07, 2011
Elevated blood pressure readings are more common in EDs than in physician's offices, according to a recent National Center for Health Statistics (NCHS) data brief.
For the study, an NCHS researcher analyzed data from the National Hospital Ambulatory Medical Care Survey for ED visits from 2007 to 2008. According to the report, a patient's blood pressure was severely elevated when systolic blood pressure was 160 mm Hg or higher and diastolic pressure was 100 mm Hg or higher. Meanwhile, moderately elevated blood pressure was defined as having systolic readings of 140 to 159 mm Hg or a diastolic reading of 90 to 99 mm Hg.
The findings showed that blood pressure was severely elevated at 16.3% of ED visits and moderately elevated at 27.2% of ED visits. Meanwhile, blood pressure was severely elevated at 6.8% of primary care office visits and moderately elevated at 20.2% of office visits.
Noting that elevated blood pressure readings may suggest underlying hypertension, the report's author said ED visits "could provide opportunities to address elevated blood pressure through patient education, initial treatment, and referral to primary care as deemed clinically appropriate" (Fiore, MedPage Today, 9/3).
Hit by a UFO?
There's an ICD code for that
September 07, 2011
NPR's "Shots" this week examined some of the "wilder codes" included in the ICD-9 CM diagnostic code book for medical research and billing.
According to "Shots," the database includes specific codes for:
- Accident caused by firearm and air gun missile—air gun, such as BB guns and pellet guns;
- Accident caused by firearm and air gun missile—paintball gun;
- Injury caused by scorpion bite;
- Injury caused by centipede bite; and
- Injury caused by spacecraft.
The precise classification system has helped Agency for Healthcare Research and Quality researchers identify national case patterns, "Shots" reports. For example, researchers were able to determine that 97% of the 20,000 gun injuries in 2008 were caused by BB and pellet guns, and that injury rates for air guns that are not paintball guns are higher in the South and in rural areas (Hensley, "Shots," NPR, 9/6).
Announcing the Advisory Board-Mercy Clinics Medical Home Health Coach Training Program
September 07, 2011
The Advisory Board and Mercy Clinics are pleased to announce our inaugural Health Coach Training course, launching this October at Mercy Clinics in Des Moines, Iowa, on October 4-5 and November 2-3.
Daily roundup: September 7, 2011
Bite-sized hospital and health industry news
September 07, 2011
District of Columbia and Maryland: NPR last week examined the creation of Walter Reed National Military Medical Center in Bethesda, a merger of the Army's Walter Reed hospital and the Navy's Bethesda medical center. According to NPR, the new medical center will have to bridge the two military branches' separate traditions and cultures. "It's a bit like merging the Yankees and the Red Sox and then making them play in 'Derek Jeter Fenway Park,'" NPR reports, adding, "Yankees fans and Red Sox Nation would never go for it—but it might make a great baseball team" (Shapiro, NPR, 9/2).
Kansas and Missouri: Findings from a Kansas City Star investigation released last week reveal that Kansas and Missouri licensing boards seldom discipline physicians with significant histories of alleged malpractice. Using data from the National Practitioner Data Bank, the newspaper determined that about 200 physicians in the two states have made payments in five or more malpractice suits since 1990 without being disciplined by a licensing board. Moreover, the states' boards do not make malpractice information publicly available, the Star found (Bavley, Star, 9/3).
New Hampshire: A new state law allows trained pharmacists to give bacterial pneumonia and shingles vaccinations, the AP/Miami Herald reports. According to one of the law's sponsors, the change will increase public access to vaccines. However, physicians groups have opposed the new law, noting that it allows pharmacists to administer a vaccination without a prescription and without notifying the patient's physician (Love, AP/Herald, 9/4).
New York: The Niagara Health Quality Coalition (NHQC) last week released its ninth annual New York State Hospital Report Card, the Albany Times-Union reports. The organization named 24 of the state's 209 facilities to its Safest Hospitals List and 20 to its Watch List. According to NHQC's president, mortality and avoidable complication rates are improving statewide (Crowley, Times-Union, 9/4).
FDA to give nutrition labels a new look
FDA recently announced plans to revise the nutrition facts label on packaged foods to provide consumers with more information about nutritional content and help offset the country's increasing rate of obesity, the AP/Washington Post reports.
One proposal to alter the label would focus on making serving sizes more accurate and emphasizing calories. Further, the labels might no longer include certain aspects, including calories from fat and statistics that indicate the amount of nutrients an average diet should include. According to the AP/Post, the discussion over the changes has been going on since 2003. Some of the changes could be proposed as soon as this year.
FDA Deputy Commissioner Michael Taylor said the effort to revamp food labels marks a shift to create a more useful nutritional tool for U.S. residents. However, he warned against expecting a grand overhaul.
Meanwhile, food industry representatives, including the Grocery Manufacturers Association, have opposed the change, saying that the current label is simple, easily recognizable and adaptable to many different food packages (AP/Post, 9/3).