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Consumer Reports names its top hospitals for safety

How safe is your hospital?

July 05, 2012

Consumer Reports on Thursday announced its "Top 10 Hospitals" based on a new safety ratings system that assessed safety performance at 1,159 hospitals across 44 states.

For the rankings, Consumer Reports analyzed CMS, state government, and Leapfrog Group data in six categories: readmissions, hospital-acquired infections, CT scan overuse, communication about new medications and discharge, complications, and mortality. The list represents just 18% of U.S. hospitals.

Hospitals were scored on a 100-point scale and more than half received an overall safety score below 50%, according to Consumer Reports. None of the surveyed hospitals received a score higher than 72.

Nearly 500 facilities received the lowest possible score for communication about medications and discharge planning, which Consumer Reports says is "worrisome because drug errors in hospitals are common" and "poor discharge planning can lead to readmissions."

Based on Consumer Reports' ratings system, the nation's ten safest hospitals are:

    1. Billings Clinic (Mont.)
    2. Saint Claire's Hospital (Weston, Wis.)
    3. Alton Memorial Hospital (Ill.)
    4. Central Vermont Medical Center (Berlin, Vt.)
    5. Kadlec Medical Center (Richland, Wash.)
    6. St. John's Hospital (Springfield, Mo.)
    7. Mayo Clinic (Phoenix)
    8. Northern Michigan Regional Hospital (Petoskey)
    9. Bon Secours St. Francis Health System (Greenville, S.C.)
    10. Memorial Hospital of Union County (Marysville, Ohio)

The latest safety rankings provide a "window into our nation's hospitals, exposing worrisome risks that are mostly preventable," says John Santa, director of the Consumer Reports Health Ratings Center. "A consumer who enters a hospital thinking it's a place to get better deserves to know if that is indeed the case."

Consumer Reports' rankings come on the heels of the Leapfrog Group's own hospital safety report, which reviewed more than 2,600 hospitals and assigned letter grades.

However, some hospitals responded that the Leapfrog's grades used "incomplete" data and the American Hospital Association announced they would investigate the not-for-profit group's methods (McCarthy, Consumer News, 7/5; McKinney, Modern Healthcare, 7/5 [subscription required]).


Study: More than 50% of cardiac patients make medication errors post-discharge

Almost 2% of errors are life-threatening

July 05, 2012

About half of all patients hospitalized for heart conditions make mistakes with their medications within a month of hospital discharge, even if they receive follow-up guidance from a pharmacist, according to a study in the Annals of Internal Medicine.

Sunil Kripalani, lead author from Vanderbilt University Hospital in Nashville, and colleagues followed 851 patients who were hospitalized for heart failure or a heart attack at Vanderbilt University Hospital and Brigham and Women's Hospital in Boston. Half of the patients were given two follow-up appointments to consult with a pharmacist, who reviewed patients' medications and offered them continuing instruction. These patients also received tools, such as a pillbox or medication chart. The other cohort received no unique post-discharge counseling.

After one month, 432—or 51%—patients made at least one potentially harmful or harmful error in taking their medication, including discontinuing the medication too early, continuing it for too long, taking the wrong dose, or missing a dose entirely. Twenty-three percent of these mistakes were considered serious and 1.8% life-threatening. Furthermore, there was no difference in error rates for those who received additional support from a pharmacist and those who did not.

Researches admit that not all patients in the intervention group received two follow-up calls. Additionally, it is unclear whether the findings would apply to patients with non-cardiac conditions.

Factors influencing adherence

Kevin Boesen, director of the Medication Management Center at the University of Arizona College of Pharmacy in Tucson, Ariz., says the study "highlights the challenge for the transition from hospital to home." He stresses the importance for patients to regularly meet with their pharmacist and primary care doctor after hospital discharge or when they fill a prescription elsewhere in order to avoid confusion. Keeping a list of drugs and using one pharmacy for all prescriptions can help physicians and pharmacists better manage their patients' medications.

According to Adam Auerback, director of inpatient cardiac services at North Shore University Hospital, economic reasons can affect adherence. A handful of patients split pills or skip doses to cut costs. Prescribing cheaper generic drugs could reduce that problem.

Furthermore, patients with a strong social support system make fewer errors, Auerback says. Those without such support "are the people we are trying to reach" (Seaman, Reuters, 7/4; Mann, HealthDay, 7/3).


Mammography rates dipped following USPSTF guidelines

July 05, 2012

The number of women in their 40s who received mammograms dropped by nearly 6% in the year after the U.S. Preventive Services Task Force (USPSTF) advised against the screenings for that age group, according to a new Mayo Clinic study.

Background on the guidelines

The USPSTF guidelines, released in 2009, recommend that women with a normal risk for breast cancer receive a mammogram every other year from ages 50 through 74.

The task force—an independent expert panel appointed by HHS—said earlier screening is unwarranted and potentially harmful because of its tendency to detect small, slow-growing tumors that might never prove lethal but could lead to unnecessary tests and treatments.

The recommendation that women in their 40s forgo routine mammograms was controversial, in part because many breast cancer patients claimed that early mammograms saved their lives. USPSTF's guidelines also conflict with those of the American Cancer Society and other medical groups that call for annual mammograms starting at age 40.

Study details

For the study, Mayo Clinic researchers examined data on eight million women enrolled in 100 U.S. health plans, comparing the number of mammograms performed between January 2006 and December 2010—before the task force's guidelines were released—with those in the year after.

Nearly 54,000 fewer women ages 40 to 49 were screened for breast cancer in the year after the release of the guidelines than in the period before, a 5.72% decrease, the study found. Although the task force recommended that older women be screened only biennially, the number of mammograms among women ages 50 to 64 remained steady, the study noted.

The researchers said the decrease among younger women was modest but nonetheless significant. The decline likely mirrored public resistance to the new guidelines, which was driven in part by the differences from the recommendations of other groups, they added (O'Connor, "Well," New York Times, 7/2).


Why hospitals fear Measure #1789

'Stakes are high' for some hospitals

July 05, 2012

Seven hospital systems and the National Quality Forum (NQF) are locked in fierce disagreement over a new readmissions measure, which hospitals say will harm patient safety and unfairly affect their finances.

The provision, known as Measure #1789 and developed by CMS and Yale University, establishes one risk-standardized, unplanned, 30-day readmission rate per hospital for all conditions and procedures related to general medicine, neurology, cardiovascular care, cardiorespiratory care, surgery, and gynecology. CMS plans to partly base Medicare payments on readmissions beginning in fiscal year 2013.

According to NQF, about 20% of Medicare beneficiaries that are discharged from the hospital are readmitted within one month, costing $15 billion annually—and that does not comprise all readmissions.

Hospitals appeal to NQF to change measure

In a formal appeal to NQF, the health systems expressed concern that the measure may lead to unintended consequences; for example, "patients may be harmed if access to the hospital is impeded" as organizations introduce new strategies intended to curb readmissions. The appellants added that hospitals are simply not yet ready for the measure.

In response, the NQF board stood by its original endorsement, although clarified that CMS will not implement the measure until it goes through a special review this summer. The board also agreed to revisit how it reaches consensus, setting up a task force to explore changes to the process.

"NQF greatly appreciates and takes to heart the comments and concerns raised throughout this project," Janet Corrigan, CEO and president of NQF, said in a release. "This current project shows that reaching consensus is difficult, but any process that balances multistakeholder interests yields important results" (Monegain, Healthcare Finance, 7/2).


How Twitter, Facebook processed last week's ACA ruling

Support swelled in initial hours, dissenters picked up steam on Friday

July 05, 2012

When the Supreme Court upheld the Affordable Care Act (ACA) last Thursday, millions of Americans turned to Twitter, Facebook, and blogs to air their feelings of elation or anger over the decision.

The Pew Research Center's Project for Excellence in Journalism in a special report analyzed the reactions, noting a swell of support in the first few hours followed by a counterattack from the law's opponents.

For the report, Pew researchers culled statements made about the ruling on Twitter, Facebook, and blogs from Thursday to Sunday. The statements included straight accounts of the ruling, predictions on its implications, and views on the law or the ruling.

Altogether, the researchers reviewed:

  • 2,133,392 statements on Twitter (18% supporting the ruling, 17% opposing it);
  • 82,770 on Facebook (29% opposing the ruling, 25% supporting it); and
  • 20,459 on blogs (19% opposing the ruling, 15% supporting it).

According to the report, "the tenor of the conversation changed over the four days following the ruling." Specifically, Pew researchers note that supporters overwhelmed dissenters on Twitter and (to a lesser extent) Facebook in the initial hours following the ruling.

However, dissenting statements outnumbered supporting statements on all three platforms by Friday, a balance that held through the weekend (Hanrahan, "Washington Wire," Wall Street Journal, 7/3; Pew report, 6/29; Pew methods, 6/29).


'Fake it til you make it'

How being optimistic can change your life

July 05, 2012

A New York Times article this week explored what it means to be an optimist, featuring interviews with several individuals who found professional success after "willing" themselves to try new or different things.

For example, one Marine Corps fighter pilot decided that he would become a professional musician after World War II—despite lacking key skills and experience, beyond playing in his high school band. But after moving to Los Angeles, he was able to use his basic competence to parlay one job opening into another, before eventually becoming a drummer for singers like Frank Sinatra and Ella Fitzgerald. After his musical career helped him get established in Hollywood, he embarked on a second career as a comedy writer for Jerry Lewis and others.

Being an optimist is not just about positive thinking, according to Elaine Fox, a psychologist at the University of Essex.

What really makes the difference is "action," Fox says. "If you sit back passively, you won’t get the job you want."

She argues that using the following techniques can strengthen what she terms the “sunny” brain:

  • Face fears head on: Go outside your comfort zone to eliminate fears, anxieties that may be holding you in check.
  • Reevaluate events in your day-to-day life: Get perspective and understand "that maybe things aren't so bad."
  • Mindfully meditate: Learn to let emotions, thoughts pass through your mind without judging them.
  • Take control over your feelings.
  • Be completely engaged: Find activities—whether a career, hobby, or volunteer effort—that are meaningful and fulfilling.
  • Laugh.

According to Fox, "Optimism is not so much about feeling happy, nor necessarily a belief that everything will be fine, but about how we respond when times get tough."

"Optimists tend to keep going, even when it seems as if the whole world is against them," she added (Brody, "Well," New York Times, 7/2).


ACO roundup: Key news from June 29-July 5

Report: 221 ACOs operated in 45 states as of may

July 05, 2012

The Daily Briefing editorial team rounds up the top accountable care stories of the past week.

  • Executives say that the Supreme Court ruling on the federal health reform law will give accountable care efforts structure and increase momentum, Modern Healthcare reports. Industry leaders note that health organization proceeded with ACO contracts, even when the future of the law appeared uncertain (Evans, Modern Healthcare, 6/30 [subscription required]).

  • A recent report from Leavitt Partners—a Salt Lake City-based consultancy—found that 221 ACOs were operating in 45 states as of May, up 35% from September 2011, when only 164 ACOs operated in 41 states. According to the report, physicians drove much of the model's growth; the number of ACOs affiliated with hospitals grew only 19% from September 2011 to May 2012 (Stagg Elliott, American Medical News, 7/2).

  • American Medical News this week explored ACOs' potential to save struggling state Medicaid programs, highlighting Oregon health reforms that aim to reduce Medicaid spending through "coordinated care organizations" (Lubell, American Medical News, 7/2).
  • From the archives: Feds buy into Oregon health reform plan with $1.9B pledge


  • A study recently published in Health Services Research found no link between patient satisfaction and a clinic's implementation of the patient-centered medical home model (O'Reilly, American Medical News, 7/2).


Daily roundup: July 5, 2012

Bite-sized hospital and health industry news

July 05, 2012

  • California: Nurses at seven Sutter Health hospitals in the San Francisco area walked off the job on Tuesday morning as part of a one-day strike following disagreement over sick leave, staffing levels, and health care payments. The walkout is the union's fifth since September 2011 and will affect 3,500 RNs and several hundred health care technicians throughout Alameda and San Mateo counties, according to a California Nurse Association spokesperson (AP/Sacramento Bee, 7/2).
  • California: San Francisco-based Dignity Health this week announced that it will acquire U.S. HealthWorks, another step in its goal to become "a national, integrated delivery network by 2020," according to a Dignity release. U.S. HealthWorks—which operates 172 medical centers across 16 states—will operate as a wholly owned subsidiary of Dignity Health. The deal is expected to close in August (Selvam, Modern Healthcare, 7/2 [subscription required]).


  • California and Nevada: Ontario, Calif.-based Prime Healthcare Services has acquired Dignity Health's St. Mary's Regional Medical Center in Reno, Nev. Dignity acquired the 269-bed hospital in 2007, when it was still named Catholic Healthcare West and affiliated with the Roman Catholic Church. Prime officials said they will maintain the hospital's "history and culture" and continue to hold daily Mass at the hospital's chapel (Selvam, Modern Healthcare, 7/2 [subscription required]).
  • Massachusetts: The Christian Science Monitor this week examined the progress of Massachusetts' 2006 health reform plan, comparing the state model to the federal health reform law. It notes that Massachusetts Division of Health Care Finance and Policy data show that about 400,000 additional residents obtain coverage under the law, bringing the rate of uninsured individuals down to 1.9% in 2010 (Loria,  Christian Science Monitor, 7/2).  


  • Pennsylvania and Tennessee: Franklin, Tenn.-based Community Health Systems recently announced the acquisition of Memorial Health Systems in York, Pa. The deal includes a pledge to build a replacement facility for Memorial's 100-bed Memorial Hospital within the next five years (Evans, Modern Healthcare, 7/2 [subscription required]).


FDA proposes rule on medical device tracking system

Rule would require UDI codes on medical devices

FDA on Tuesday announced that it has released a proposed rule to create a unique device identification (UDI) system to track medical devices.

Background

There currently is no uniform labeling system for medical devices, making it difficult to track down problematic equipment used by hospitals and patients. A UDI system would allow FDA officials to electronically track medical tools and promptly recall any devices that could jeopardize patient safety.

Lawmakers recently took steps to expedite the creation a UDI system by adding language to a FDA user fee bill (S 3187) that would establish a deadline for FDA to create a UDI system.

Last week, the Senate passed the House-approved bill and sent it to President Obama, who is expected to sign the measure into law.

Details of FDA's proposed rule

FDA in a statement said it released the proposed rule in response to the new user fee legislation.

The proposed rule would require medical device manufacturers to place UDI codes on their products to identify each device's make, manufacturer, and lot number.

Such codes would be stored in a public database so regulators, physicians, and companies could monitor safety issues related to the devices.

The proposed rule is scheduled to be published in the Federal Register within a week. After publication, FDA will accept public comments on the proposed rule for 120 days (Goedert, Health Data Management, 7/3; Perrone, AP/U-T San Diego, 6/26; AP/Sacramento Bee, 7/3; Yukhananov, Reuters, 7/3; FDA release, 7/3).