The Daily Briefing

News for Health Care Executives

Are you getting the most out of your patient and family advisory council?

February 22, 2012

Few nursing leaders dispute the ability of Patient and Family Advisory Councils to enhance the patient experience through leveraging the unique perspective of former patients. However, most acknowledge these groups often fail to realize their full potential. All too often, former patients turned volunteers become siloed from the larger organization in their efforts to create a best-in-class patient experience.

This disconnect can result in Patient and Family Advisory Council members pouring time and energy into initiatives that are at cross-purposes with staff-led initiatives to enhance the patient experience. Worse yet, at many institutions, the most promising ideas discussed at Patient and Family Advisory Councils may never be put into action.

Make the most of your Patient and Family Advisory Council
To ensure Patient and Family Advisory Councils deliver their full potential to the larger institution, the Nursing Executive Center recommends two key strategies: 

1. Past hospital experience should inform volunteer project selection
Nurse leaders should encourage patient volunteers to work on personally meaningful projects to enhance the patient experience. Such projects should be informed directly by a former patient’s own hospital experience—namely, a less than optimal experience that he or she would endeavor to improve for future patients.

For example, at Vidant Medical Center, formerly known as Pitt County Memorial Hospital, the 861-bed flagship hospital of the Greenville, North Carolina-based Vidant Health System, one volunteer tapped into her experience as a patient in the medical ICU.  During her stay, she was too disoriented to distinguish between the buttons that activated the nurse call light and the television. Fear and embarrassment prevented her from admitting this confusion to the care team at the time. As an advisor, she spearheaded the purchase of new nurse call buttons that were easier to manipulate for medical ICU patients.

2. Integrate volunteers into existing committees and teams
To prevent Patient and Family Advisory Councils from becoming siloed, patient experience leaders should integrate advisors into pre-existing hospital organizations, such as quality committee meetings, board meetings, and performance improvement teams.

To ensure that advisors feel comfortable participating on hospital committees composed primarily of hospital staff, assign advisors a staff committee “buddy.”  This individual should be prepared to orient the advisor to committee processes and mores in addition to conducting a quick debrief with the advisor following committee meetings. The goal of this relationship is to maximize advisor comfort in providing his or her perspective on committee agenda items and prepare advisors to deliver their message in most effective way possible.

Register now
Nursing Executive Center members, join us at the national meeting, Delivering on the Promise of Coordinated, Patient-Centered Care to learn more. Not a member of the Nursing Executive Center? Learn more on our website.

White House again changes birth control rule

Faith-based hospitals no longer required to cover contraception

February 10, 2012

In a reversal, President Obama on Friday announced that religious-affiliated organizations—including certain hospitals and universities—are no longer required to cover employees' birth control.

HHS instead will require insurers to offer no-cost contraception directly to women. As a result, workers at religious-affiliated organizations can request free family planning—which insurers must provide—removing the burden from employers.

The announcement represents a shift from a final rule the White House issued in late January, which said religious-affiliated organizations had until Aug. 1, 2013, to comply with the rule. According to CNN, the White House settled on the compromise after receiving pushback from religious groups and conservative lawmakers.

A White House statement said the new policy will allow women to "have free preventive care that includes contraceptive services no matter where she works." In addition, it said the policy ensures that religious-affiliated organizations that object to providing contraceptive services will not have to cover them.

Sister Carol Keehan, president of the Catholic Health Association, which represents Catholic hospitals, said the group is pleased with the accommodation. "The framework developed has responded to the issues we identified that needed to be fixed," Keehan said, adding that the resolution "protects the religious liberty and conscience rights of Catholic institutions."

Planned Parenthood also has said it backs the decision. "We believe the compliance mechanism does not compromise a woman's ability to access these critical birth control benefits" (White House fact sheet, 2/10; Simon and Bohan, Reuters, 2/10; AP/Boston Globe, 2/10; Silverleib, CNN, 2/10; McCarthy, National Journal, 2/10 [subscription required]; Zigmond, Modern Healthcare, 2/10 [subscription required]).

Berwick: What the media missed in the health care debate

Former CMS chief discusses health reform, nomination media coverage

February 10, 2012

In a recent interview with Association of Health Care Journalists (AHCJ) President Charles Ornstein, former CMS Administrator Don Berwick reflected on the media's coverage of health reform—and highlighted what fell through the cracks.

Overall, Berwick said he had a "favorable impression" of how the press covered CMS during his tenure, noting that it often "felt like dealing with experts." However, he called for more in-depth coverage of complicated health care issues.

"There weren't a sufficient number of longer in-depth analyses of what really was going on and what were the pros and cons of the choices the government, and our nation, are making," Berwick said. "I would think sound media would be addressing the issues with the same discipline that we were using internally."

In addition, Berwick noted the media's tendency to "wait for the two-word phrase that can become the headline." He said the media during his nomination process "repeated accusations about me that were not accurate," namely the "irresponsible and inaccurate claims from the people that opposed my nomination that I was interested in rationing and withholding care." The claims, he said, were "180 degrees wrong."

When it comes to the federal health reform law, Berwick acknowledged "a great communication paradox," noting that even he did not fully understand the details of the law prior to joining the administration. Although he said it is not "journalism's burden to sell the law," he said it is their job to analyze it and that the "positive aspect of it has been too sotto voce in the reports."

Berwick in the interview also outlined several health care issues that he says deserve more media coverage. For example, he said the media has not sufficiently addressed "the more-is-better myth" of health care. He noted that many outlets have not explored the various health care innovations that have helped organizations over the past 30 years cut costs and improve care.

Berwick also said he would like to see more coverage of Medicaid. "Although Medicare inside the beltway attracts the most attention, I lost much more sleep about Medicaid than about Medicare," he said. He urged the media to "keep the Medicaid story alive" (Ornstein, AHCJ, 2/9). 

NASA takes health care to infinity and beyond

NASA medical breakthrough could save millions of lives on Earth

February 10, 2012

What happens when astronauts get sick in space? Gizmodo this week spotlighted the NASA Biocapsule, an implantable device that could instantly detect and treat health problems both in space and on Earth.

How the biocapsules work
NASA Biocapsules would be inserted subcutaneously—likely in the thigh—through a simple outpatient procedure that requires only local anesthesia and stitches. Each biocapsule is made of carbon nanotubes that contain cells that detect certain changes in the body and secrete appropriate therapeutic molecules that cross the capsule wall by diffusion.

According to Gizmodo, no known enzyme is capable of breaking down the biocapsules' nanostructure. As a result, they would have no expiration date and could deliver metered doses of a treatment for years.

Potential applications in space
NASA's primary application for the biocapsule is mitigating the effects acute radiation exposure, which can damage bone marrow and destroy the immune system. However, different capsules could be created to target other potential health problems astronauts might face, including heat, exhaustion, and sleep deprivation.

Potential applications on Earth
Scientists are expected to begin testing the biocapsules in animal trials this year, and human trials will begin shortly after. Barring large-scale problems, David Loftus, the NASA physician who created the biocapsule, says physicians on Earth could be using the tiny implant to treat various conditions—such as diabetes—within 10 to 15 years.

For example, a diabetes biocapsule would contain pancreatic islet cells—or cells engineered to behave like them—allowing the device to monitor glucose levels and secrete insulin. Patients with low-insulin needs could benefit from a single capsule, while those with high-insulin needs could require several capsules.

Meanwhile, Gizmodo notes that biocapsules also could help treat cancer—capsules implanted into a tumor could directly deliver high doses of chemotherapy—or severe allergies, which would allow certain patients to leave their epinephrine shot at home (Rose, Gizmodo, 2/8).

Labeling health plans: Insurers must list benefits in easy-to-read format

Final rule calls for standardized explanations of benefits

February 10, 2012

HHS on Thursday released final rules for the standardized explanations of benefits that insurers will be required to provide consumers this fall under the federal health reform law.

The new forms are intended to be easy to read, and include a glossary of standard insurance terms and standardized descriptions of what plans will cover. Premium information will not be provided on the forms, but Obama administration officials said the data should be easily accessible from employers or directly from a health plan.

The six-page summary also will include coverage examples that provide estimates of the cost of treatment for a typical enrollee to manage his or her diabetes or have a child. HHS had considered including breast cancer treatments as a third example but dropped it from the final rules.

Steve Larsen, head of CMS' Center for Consumer Information and Insurance Oversight, said, "There was concern expressed that breast cancer versus the other ones was a more complicated treatment scenario, that it wasn't always standardized across insurers or even the type of cancer." Up to six additional coverage examples might be required in the future, Larsen said.

The forms will be required beginning Sept. 23, despite calls from insurers for the rules to become effective 18 months after HHS released them. Insurers are permitted to offer the summaries online but must tell consumers that they can receive a hard copy promptly upon request. Insurers that fail to comply with the rules could pay up to $1,000 per enrollee, Larsen said.

Acting CMS Administrator Marilyn Tavenner said the forms will "allow people to make an apples-to-apples comparison of plans" She said, "If an insurance plan offers substandard coverage in some area, they won't be able to hide it in dozens of pages of text."

Health insurers said that they already provide user-friendly materials to consumers and that the rules will result in duplication and increased costs (McCarthy, National Journal, 2/9 [subscription required]; Alonso-Zaldivar, AP/San Francisco Chronicle, 2/9; Baker, "Healthwatch," The Hill, 2/9).

Study: Only 25% of C. diff infections acquired in the hospital

Findings show most patients become infected outside the hospital

February 10, 2012

Challenging conventional wisdom about Clostridium difficile, a study in PLoS Medicine suggests that most cases of C. difficile in hospital patients are actually acquired outside of the hospital.

Researchers from John Radcliffe Hospital in Oxford, England tested almost 30,000 stool samples from 15,000 patients for C. difficile and found 4.4% were positive for the infection. With further genotyping, the researchers uncovered 69 different types of C. difficile which they used to construct possible networks and transmission patterns. They found that 66% of cases of the infection were not linked to known cases, and only 23% shared the same type of C. difficile as found in another patient in the ward known to be infected.

The researchers wrote that the findings show that current infection control measures could be falling short. "A better understanding of other routes of transmission and reservoirs is needed to determine what other types of control interventions are required to reduce the spread of C. difficile" they conclude.

However, an accompanying perspective in PLoS Medicine questions whether the study results are broadly applicable. According to Stephan Harbarth of the University of Geneva Hospitals and Medical School in Switzerland and Matthew Samore of the University of Utah School of Medicine, researchers only looked at the possibility of transmission within single wards while transmission between wards was not assessed.

They note that proving that most cases of C. difficile are imported from outside the hospital would be "revolutionary" but the findings for this study are "not yet sufficient to prove this hypothesis" (Smith, MedPage Today, 2/8; Walker et al., Medical News Today, 2/8).

Why men may suffer more heart disease than women

Study finds Y chromosome may account for increased risk

February 10, 2012

Men may be at a higher risk for developing heart disease based on the type of Y chromosome they carry, a recent study in The Lancet finds.

Although heart disease is the leading cause of death for both men and women, two-thirds of heart disease patients are male, and the condition affects men 10 to 15 years earlier than women, the New York Times reports.

For the new study, British researchers analyzed data for 3,233 men who were enrolled in two large heart disease studies. They found that 90% of men carried one of two versions of the Y chromosome: either haplogroup I or haplogroup R1b1b2.

According to the results, men who carried the haplogroup I version had a 50% greater risk of heart disease than the other men independent of traditional risk factors such as cholesterol, smoking, and diabetes.

Hélène Wilson of the British Heart Foundation, which partly funded the study, notes that "[l]ifestyle choices such as poor diet and smoking are major causes [of heart disease], but inherited factors carried in DNA are also part of the picture." She adds, "The next step is to identify specifically which genes are responsible and how they might increase heart attack risk" (Roberts, BBC News, 2/8; Kolata, New York Times, 2/8).

Editor's picks

Our reads for the weekend

February 10, 2012

The Daily Briefing editorial team highlights several studies and articles that got us talking this week.

Breaking down body language: The New York Times' Pauline Chen examines the importance of a physician’s nonverbal communication. More.

Where do all the pink ribbon dollars go? Critics put Susan G. Komen for the Cure under the microscope, Reuters reports. More.

Why wait to sip your coffee if you can inhale it? The AP/Detroit Free Press examines a controversial new way to ingest caffeine. More

Cure vs. treatment: The Atlantic's John-Manuel Andriote explains how managing-—not curing—Type 2 diabetes became the norm. More.

At one college in Pennsylvania, students can buy Plan B from a vending machine for $25, ABC News reports. More.

Where you sit on the airplane may matter: Travelers sitting in the window seat may have a higher risk of deep vein thrombosis. More.

The Joliet Herald News illustrates the challenges of moving a hospital, 60 departments, 100s of staffers, and at least 125 patients. More

Could a little electricity jolt your memory? A new study in NEJM finds a benefit to deep brain stimulation. More.

According to CNN, hundreds of former football players have filed lawsuits against the NFL for allegedly failing to mitigate the sport's health risks. More.  

The Art of Medicine: Illustrating 2,000 years of anatomy

New book offers visual history of medicine and anatomy

February 10, 2012

Our understanding of medicine has evolved dramatically over the past 2,000 years, and a recently released book attempts to outline its history using pictures, artifacts, and more.

Written by medical historian Julie Anderson and science writers Emm Barnes and Emma Shackleton, The Art of Medicine: Over 2,000 Years of Images and Imagination offers a visual history of anatomy and medicine through paintings, drawings, prints, sculptures, artifacts, manuscripts, manuals, and digital art from the United Kingdom's Wellcome Collection.

For example, the collection includes 18th-century anatomical waxworks with removable organs, 20th-century lithographs advertising gout remedies, and leaves from hand-colored plant and herb guides. 

According to Shackleton, "the most powerful message the collection came to say was one about continuity." She notes that the collection spans major developments in medicine and diverse art practices that represent the human condition, which "is a thread connecting the past, present, and future" (Mustich, Salon, 2/2; Popova, The Atlantic, 2/8).

Is your cat making you crazy?

Odd theory getting mainstream support

February 10, 2012

A Czech scientist has advanced a theory that a parasite found in housecats can cause schizophrenia in their owners, The Atlantic reports.

Jaroslav Flegr's theory—that the parasite Toxoplasma gondii can pass from cats to humans and cause changes in the brain—sounds "psychedelic" but is starting to gain mainstream support, according to The AtlanticStanford University's Robert Sapolsky, one of the world's most prominent neuroscientists, says he has "no reason to doubt" Flegr's work.  

Flegr developed the theory after noticing changes in his own behavior, such as becoming reckless when crossing busy roads or confronting Czechoslovakia's Communist leaders. He questioned whether his loss of inhibitions was tied to parasites that had affected his neural pathways, leading Flegr to an uncoventional path of research that found surprising connections between infected individuals' reaction times and decision-making.

For example, adult Czechs who tested positive for the parasite T. gondii were more than twice as likely to be in a traffic accident as their uninfected peers.

Experts also suggest T. gondii may not be the only parasite potentially affecting brain chemistry. According to Sapolsky, "there are [probably] scads more examples of this going on in mammals, with parasites we’ve never even heard of" (McAuliffeThe Atlantic, March 2012).  

Will you be my health policy valentine?

How an HHS staffer's tweet went viral

February 10, 2012

Dan Diamond, Managing Editor

You don't need Twitter to love Valentine's Day—but it certainly helps to send #HealthPolicyValentines to that special wonk in your life.

The clever (if nerdy) hashtag quickly jumped from social media on Thursday night to the mainstream press by Friday.

And playing the role of Cupid was HHS staffer Emma Sandoe, who was struck by love—for a clever idea—on her commute home.

Sharing the love
When creating the hashtag on Twitter, Sandoe thought "it would be funny to tweet one 'health policy valentine' everyday until Valentine's Day, but as soon as I started, I couldn't stop."

After Sandoe dashed off several tweets, the hashtag was quickly picked up by reporters like Politico's Kate Nocera and was soon trending across Twitter, with would-be Cyranos and Lord Byrons weighing in from coast-to-coast.

The clever idea inspired numerous wonky spin-offs, too. Most prominent? #FedValentines, which was coined by economist Justin Wolfers; organizations like NPR, former White House advisor Austin Goolsbee, and even the San Francisco Federal Reserve ultimately weighed in. (The New York Times and Wall Street Journal have listed their top #FedValentines.)

Sandoe picked one of her favorite tweets for the Briefing, and here are several more that made our team laugh out loud too:

Tips for a viral hashtag?
Sandoe confesses that success caught her by surprise. "To be honest, I put my phone down as soon as I got home and didn't realize it had gotten so popular" until friends sent her emails, she said.

As a newly minted viral star, Sandoe does have tips for creating a catchy hashtag. It should be simple and easy to understand, she said. It clearly helps when the hashtag is timely.

Meanwhile, watching the love for her idea spread has been hilarious, she added. "Everyone should embrace their inner nerd," Sandoe stressed.

(And on Valentine's Day, presumably embrace those who are outwardly nerdy, too.)

  • Spread the love: Pass us your #HospitalValentines, either in the comments below or via Twitter. We'll pick the best ones for Tuesday's issue.

What's the right Medicare Shared Savings model for your organization?

February 10, 2012

Let The Advisory Board’s Southwind division help you make the decision, submit the application, and design and implement the program. Join Laurie Sprung, Vice President for a complimentary encore presentation that explores our MSSP implementation initiative. More.


Daily roundup: Feb. 10, 2012

Bite-sized hospital and health industry news

February 10, 2012

  • California: A forecast by the California Hospital Association highlights the challenges that hospitals in the state likely will face in 2012, including economic hurdles and aggressive union negotiations. The forecast says some hospitals, especially rural facilities, could be at risk for closure (Payers & Providers, 2/9).
  • Illinois and Wisconsin: Wheaton, Ill.-based Wheaton Franciscan Healthcare on Wednesday sold its stake in Affinity Health System to Milwaukee-based Ministry Health Care. Wheaton and Ministry previously had jointly owned Affinity, which operates hospitals in Appleton, Oshkosh, and Chilton (Boulton, Milwaukee Journal Sentinel, 2/8).
  • New York: NuHealth System has submitted a proposal to the state seeking $30 million and antitrust clearance from New York to cut 50 beds from 481-bed Nassau University Medical Center (NUMC) in East Meadow and affiliate more closely with North Shore-Long Island Jewish Health System. The proposal would restructure operations, stabilize finances, and improve quality at the struggling NUMC (Evans, Modern Healthcare, 2/8 [subscription required]).
  • Oregon: Randall Children's Hospital on Feb. 26 will move its patients to a new, nine-story building on the Legacy Emanuel Medical Center campus in Portland. The new facility is four times larger than the current facility. It features private patient rooms with space for families, a terrace garden for young patients, and artwork selected to create a soothing environment (Rojas-Burke, Oregonian, 2/8).

CMS launches grants initiative to reduce pre-term birth rates

CMS' Center for Medicare and Medicaid Innovation this week launched the "Strong Start" initiative, which will award more than $40 million in grants to help researchers develop pre-term birth prevention strategies.

According to HHS, the number of infants born prematurely—before 39 weeks gestation—has increased by 36% over the past two decades to more than 500,000 pre-term births annually. Officials note that a 10% reduction in pre-term births could save Medicaid more than $75 million annually. HHS also estimates that medical costs for babies delivered pre-term in their first year of life averages about $20,000, compared with $2,100 for full-term infants.

Under the new initiative, health care providers and other eligible recipients will receive the grants to test different care delivery and case management models, such as those adopted at birth centers and maternity care homes, and through group visits with other pregnant women (Pecquet, "Healthwatch," The Hill, 2/8; Zigmond, Modern Healthcare, 2/8 [subscription required]; McCarthy, National Journal, 2/8 [subscription required]).