The Daily Briefing

News for Health Care Executives

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February 16, 2012

Gallup names healthiest U.S. states

Hawaii boasts highest well-being, West Virginia comes in last

February 28, 2012

How healthy is your state? Hawaiians have the highest well-being in the nation, while West Virginians have the lowest, according to the Gallup-Healthways Well-Being Index for 2011, which analyzed physical and emotional health.

For the rankings, Gallup in 2011 conducted 350 surveys of 1,000 U.S. residents, who answered questions about physical health, lifestyle behaviors, emotional health, work environment, and basic access to health care and food.

Based on the responses, the 10 states that had the highest Well-Being Index scores were:

    1. Hawaii (70.2/100);
    2. North Dakota (70.0);
    3. Minnesota (69.2);
    4. Utah (69.0);
    5. Alaska (69.0);
    6. Colorado (68.4);
    6. Kansas (68.4);
    8. Nebraska (68.3);
    9. New Hampshire (68.2); and
    10. Montana (68.0).

According to Gallup, Hawaii residents had the best healthy behaviors and reported positive eating and exercise habits, as well as lower smoking rates. In addition, Hawaiians were the most likely to say they had laughed or smiled the day before being surveyed, and the least likely to report daily stress or a depression diagnosis.

Meanwhile, the states that had the lowest Well-Being Index scores were:

    1. West Virginia (62.3);
    2. Kentucky (63.3);
    3. Mississippi (63.4);
    4. Delaware (64.2);
    5. Ohio (64.5);
    6. Alabama (64.6);
    7. Arkansas (64.7);
    8. Missouri (64.8);
    9. Florida (64.9);
    10. Tennessee (65.0); and
    10. Nevada (65.0).

Nine of the top 10 states for well-being were located in the Western or Midwestern regions of the country, while half of the bottom 10 states were in the Southern region. According to Gallup, the index has reflected this geographic pattern since Gallup and Healthways began monitoring well-being in 2008. 

National Well-Being Index drops
Overall, the U.S. Well-Being Index for 2011 was 66.2 out of 100, reaching its lowest point since 2008. In comparison, the index for 2010 was 66.8.

Although the life evaluation index increased from 2008 to 2011, work environment dropped from 51.4 in 2008 to 47.2 in 2011, while basic access dropped from 83.6 in 2008 to 81.9 in 2011.

According to Gallup, no state has posted a significant well-being improvement since the 2008 financial crisis, indicating that continued economic struggle poses a challenge to well-being improvement efforts (Standish, Gallup, 2/27; Song, "Healthland," Time, 2/27; Hellmich, USA Today, 2/27; Pacific Business News, 2/27).

Five hospitals receive first palliative care certifications

Joint Commission standards emphasize patient engagement

February 28, 2012

The Joint Commission this week awarded its first advanced certifications for palliative care to five hospitals that it said demonstrated a focus on patient-centered treatment and teamwork.

The five hospitals that received advanced certifications are:

  • Regions Hospital (St. Paul, Minn.);
  • Strong Memorial Hospital (Rochester, N.Y.);
  • Mt. Sinai Medical Center (New York City); 
  • St. Joseph Mercy Oakland (Pontiac, Mich.); and 
  • The Connecticut Hospice, Inc. (Branford, Conn.).

Specifically, The Joint Commission said the hospitals showed that they have a formal palliative care program headed by an interdisciplinary team, leadership support, a focus on patient and family engagement, and processes to coordinate care among providers. The facilities also use evidence-based national guidelines or expert consensus to guide care decisions.

"Seriously ill patients will benefit from the decision by these five leading hospitals to follow national standards and evidence-based guidelines that emphasize the need for expert caregivers to work together as teams with patients and their families," says Michele Sacco, an executive director at The Joint Commission. "Certification signifies that these hospitals are committed to patient and family-centered care to optimize the quality of life for patients with serious illnesses" (Joint Commission release, 2/27; Carlson, Modern Healthcare, 2/27 [subscription required]).

Should states limit ED visits?

Hospitals, physicians say Washington state policy goes too far

February 28, 2012

As Washington state inches closer to eliminating Medicaid payments for all non-emergent ED visits, physicians and hospital leaders are debating whether the plan will jeopardize patient care and increase their costs.

Washington ED limits
Beginning April 1, Washington state no longer will pay for Medicaid patients who visit the ED with one of about 500 diagnoses that include common infections, mild burns, and bruises. The state instead will pay only a $50 screening fee for Medicaid patients enrolled in a private-plan version of the program.

The new rules are more drastic than rules introduced last year, which would have limited Medicaid patients to three non-emergent ED visits per year. Washington emergency physicians in October 2011 filed a lawsuit against the state health department over the restrictions, and a judge struck them down in November 2011, saying the state did not follow proper rulemaking procedure.

Other states consider Washington policy
According to National Academy for State Health Policy Executive Director Alan Weil, other states are monitoring the Washington policy as they look for ways to deter unnecessary ED use among Medicaid patients.

Meanwhile, Kaiser Family Foundation data show that 43 U.S. states so far have implemented measures to curb unnecessary ED visits. Some states, such as Iowa and Tennessee, have adopted policies similar to Washington's but have rules exempting younger patients.

Providers push back
Physicians and hospitals say the Washington ED limits go too far. They note that federal law requires them to screen and stabilize patients—a process that might involve certain exams and tests.

In addition, many hospitals routinely provide care to patients for conditions Washington considers non-emergent, such as urinary-tract infections. Hospitals say if they are forced to do uncompensated work, the costs eventually could be shifted to private health insurers.

In response to criticism of the rule, Washington health officials say patients deemed non-emergent should be redirected to less expensive medical settings, such as urgent-care clinics. "We will be happy to work with doctors and hospitals to ensure care is done appropriately and in the appropriate time frame," says Jeff Thompson, chief medical officer for the Washington State Health Care Authority, which oversees the Medicaid program (Wilde Mathews, Wall Street Journal, 2/25).

Stents no better than medicine for stable CAD

Mortality, MI rate similar for both treatments

February 28, 2012

Standard medical care for stable coronary artery disease (CAD) patients prevents chest pain, myocardial infarction (MI), and death as effectively as stent implantation, according to a study in the Archives of Internal Medicine.

For the study, Stony Brook University Medical Center researchers reviewed eight randomized trials that monitored 7,229 patients with stable coronary artery disease for an average of more than four years. The trials compared the effectiveness of initial percutaneous coronary intervention (PCI) with standard medical therapy, such as beta blockers, ACE inhibitors, statins, or daily aspirin.

According to the findings, the mortality rate for PCI was 8.9%, compared with 9.1% for medical therapy. Meanwhile, the rate of non-fatal MI was 8.9% among PCI patients and 8.1% among patients receiving medical therapy alone.

Although the study found that about 30.7% of patients who took only standard medical treatment eventually underwent PCI, about 21.4% of patients who initially underwent PCI required a second procedure—a difference researchers say was not statistically significant (Bakalar, New York Times, 2/27; Reinberg, HealthDay, 2/27).

Survey: Many hospitals support 'bring your own device' policies

Findings show EHRs most widely supported mobile application

February 28, 2012

A majority of hospital-based IT professionals say their organization embraces "bring your own device"—or BYOD—policies that allow employees to use their personal mobile devices at work, according to a recent survey.

For the survey, Aruba Networks interviewed more than 130 hospital-based health IT professionals. Although 85% of respondents said their organization has a BYOD policy, the organizations varied in the amount of data they allowed personal mobile devices to access. The survey found that:

  • 53% of respondents said their organization only allows personal mobile devices to access the Internet; 
  • 24% said their organization provides personal mobile devices with limited access to hospital applications; and 
  • 8% said their organization provides personal mobile devices with full access to the hospital network.

Types of mobile devices supported
The survey also found that:

  • 83% of respondents said their organization supports Apple iPads; 
  • 65% said their organization supports Apple iPhones and iPod Touches; 
  • 52% said their organization supports Blackberry devices; and 
  • 46% said their organization supports Android-based devices.

Additional findings
The survey found that electronic health record (EHR) applications are the most widely supported application on mobile devices, with 60% of respondents saying their organization supports the use of mobile EHR apps. The next most widely supported mobile apps include picture archiving and communication systems, secure messaging, and voice-over IP.

The survey also found that more than 75% of respondents said their organization provides Internet access to patients and hospital visitors, but 58% said they use open networks without password protection to do so (Mearian, Computerworld, 2/24; Dolan, MobiHealthNews, 2/23).

Judges stifle BCBS bid to end anticompetitive agreements case

Decision keeps case alive, trial date set for April 2013

February 28, 2012

A three-judge panel of the 6th U.S. Circuit Court of Appeals on Thursday rejected an appeal by Blue Cross Blue Shield of Michigan (BCBS) to end a lawsuit that alleged that the insurer stifled competition with improper hospital contracts.

According to the lawsuit—which was brought by the Department of Justice and the Michigan Attorney General's office—BCBS signed contracts with more than 50% of Michigan's acute-care hospitals that prevented the facilities from charging other insurers lower prices. The plaintiffs argued that in some cases BCBS agreed to reimburse hospitals at a higher rate if they charged competing insurers more.

U.S. District Judge Denise Page Hood in August denied a request by BCBS to dismiss the lawsuit based on lack of jurisdiction by a Detroit-based district court, which would have protected the insurer under the "state-action" doctrine.

BCBS appealed the decision, arguing that the ruling could qualify for a narrow type of appeal—called interlocutory appeal—that can be heard in front of a circuit court without final judgment in a case. The three-judge panel said the BCBS case did not qualify, and the case could not be considered without a final judgment.

Helen Stojic, a BCBS spokesperson, noted that the appeal was rejected on procedural grounds, not on the merits of the case. According to Modern Healthcare, discovery in the case is ongoing, and the trial is scheduled to start in April 2013 (Carlson, Modern Healthcare, 2/26 [subscription required]).

Mass General researchers produce human eggs from stem cells

Finding could bolster infertility treatments for women

February 28, 2012

Massachusetts General Hospital researchers say they have successfully used stem cells to generate human egg cells, a finding that eventually could help treat infertility in women.

For the study—which was published in Nature Medicine—researchers used human ovaries donated to science by women at the Saitama Medical Center in Japan and isolated certain reproductive cells that they showed would produce immature egg cells when cultivated in a laboratory.

The cells were injected into pieces of human ovarian tissue, which then were transplanted under the skin of mice. The researchers discovered that the injected egg cells produced follicles—the ovarian structure that fosters egg growth—in addition to some mature eggs containing a single set of chromosomes.

According to NPR's "Shots," the results eventually may be used to treat women who have become infertile because of age, chemotherapy, or menopause.

Independent researchers have hailed the experiment, but cautioned that its real-world applications remain years away. David Albertini, a female reproduction expert at the University of Kansas, called the results "a real technological tour de force." However, Albertini added that study authors have yet to prove that the newly created egg cells could be actually used in fertility treatments (Wade, New York Times, 2/26; Stein, "Shots," NPR, 2/27; AP/Los Angeles Times, 2/26). 

Daily roundup: Feb. 28, 2012

Bite-sized hospital and health industry news

February 28, 2012

  • Massachusetts: Massachusetts hospital leaders predict another round of community hospital mergers in 2012 after last year's "wave of consolidations and new alliances," the Brockton Enterprise reports. This year's first hospital merger in the state occurred in early January when Beth Israel Deaconess Medical Center acquired Milton Hospital (Riley, Brockton Enterprise, 2/27).
  • Pennsylvania: Approximately 1.1% of the 1.8 million patients admitted to state hospitals in 2010 acquired an infection during their stay, according to a report released last week by the Pennsylvania Health Care Cost Containment Council (PHC4). The report also showed that 31.3% of patients who acquired an infection were readmitted within 30 days, compared with 6.3% of patients who did not acquire an infection (PHC4 release, 2/24; Fabregas, Pittsburgh Tribune-Review, 2/24).
  • Nevada: Twenty of the state's 33 general hospitals lost money in the third quarter of 2011, according to a recent financial report on Nevada health care systems. "That would be a disaster in any industry and it's a bit of a disaster here," says Nevada Hospital Association's Dwight Hansen (Mullen, Reno Gazette-Journal, 2/24).
  • Washington: The boards of Seattle-based Virginia Mason Medical Center and Kirkland-based Evergreen Healthcare last week approved a strategic partnership. Health system leaders say they plan to merge services, such as cardiac care and home health care, to avoid duplication and lower costs, but the organizations will maintain separate finances and management structures (McLain, "The Today File," Seattle Times, 2/22).

Perfecting the Nursing Strategic Plan

February 28, 2012

Join us for a complimentary webconference that will provide detailed guidance on crafting a strategic plan for the coming decade and will equip nurse leaders with a framework to ensure their strategic plans align with their health system's strategic goals. More.

Majority of registered voters in swing states support health law repeal

Thirty-two percent of registered voters in 12 swing states said they would "strongly favor" repealing the federal health reform law if a Republican is elected president this year, according to a USA Today/Gallup poll.

The poll of 1,137 registered voters in Colorado, Florida, Iowa, Michigan, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Virginia, and Wisconsin was conducted between Feb. 14 and Feb. 21.

The poll found that health care ranks just behind the economy and the deficit as one of the most critical issues facing the United States. Voters under 30 were more likely to call the federal health reform law "a good thing," but opposition increased among older age groups (Page, USA Today, 2/26).