Accountable care roundup: CMS extends Pioneer ACO program application deadline
CMS extends Pioneer ACO program application deadline
June 9, 2011
CMS has pushed back the application deadline for the Pioneer accountable care organization (ACO) program from July 18 to Aug. 19. The agency also announced a new Medicare patient-centered medical home demonstration project that will award $42 million across three years to as many as 500 community health centers.
CMS has extended the application deadline for the Pioneer ACO program from July 18 to Aug. 19, Modern Healthcare reports. The agency also extended the deadline for submitting a nonbinding letter of intent for the program from June 10 to June 30. The delay comes after providers requested more time to gather support for the program within their organizations (Daly,Modern Healthcare, 6/8 [subscription required]).
- CMS this week announced a new Medicare patient-centered medical home demonstration project that will award $42 million across three years to as many as 500 community health centers, CQ HealthBeat reports. The grants will help Federally Qualified Health Centers improve quality of care, lower costs, and coordinate patient care. Participating centers will be required to adopt electronic health record systems and help patients manage chronic conditions. The centers will be paid a $6 monthly care management fee for each Medicare patient receiving primary care services in addition to the standard reimbursement. Up to 195,000 Medicare patients would be involved in the demonstration. Applications for the program are due Aug. 12 (CMS release, 6/6 Adams, CQ HealthBeat, 6/6 [subscription required]).
Illinois: Northwestern Memorial Physicians Group (NMPG)—a large physicians group affiliated with Northwestern Memorial Hospital in Chicago—and Walgreen are partnering on a "coordinated health care program" designed to facilitate "appropriately-timed pharmacist clinical interventions," the Chicago Tribune reports. According to NMPG's president, the partnership aims to give patients "a richer conversation with their primary doctor that is supported by the pharmacy documentation." The program—which initially will be rolled out to Northwestern Memorial and Walgreen employees—will focus on managing chronic diseases such as hypertension, diabetes, asthma, and hyperlipidemia (Japsen, Tribune, 6/8).
Pennsylvania: Monongahela Valley Hospital and Jefferson Regional Medical Center are partnering with Highmark Inc., Western Pennsylvania's largest health insurer, in a three-year pilot program to reduce readmissions of patients with congestive heart, chronic obstructive lung, and coronary artery diseases, the Pittsburgh Tribune-Review reports. Using a Robert Wood Johnson Foundation grant, the program—which was organized by the Pittsburgh Regional Health Initiative—will create an ACO called the Pittsburgh Accountable Care Network. According to a University of Virginia public health professor, the proposed ACO is a "way better idea" than a typical ACO because it focuses on specific diseases (Conte, Tribune-Review, 6/6).
ACCOUNTABLE CARE UPDATE
Understand the Pioneer ACO Model
CMS recently announced the Pioneer ACO Model, an accelerated path to ACO formation for organizations with prior experience managing risk. A new Health Care Advisory Board white paper offers details about this new model and eight key conclusions for organizations weighing participation. More>>
New accountable care resources
The Advisory Board has created a comprehensive set of accountable care resources and—for the first time—made many of them available to members of all programs through a centralized location on our website. Please visit www.advisory.com/accountablecare for the best of our accountable care strategy briefs, webinars, toolkits, videos, and onsite offerings from across our research programs.
Build platforms for shared accountability
Design and implement physician integration models that meaningfully enhance cost and quality performance. See the Advisory Board's new Accountable Care Solutions page by clicking here.
Appeals court hears arguments in largest health law challenge
June 9, 2011
A three-judge panel at the 11th U.S. Circuit Court of Appeals in Atlanta on Wednesday heard oral arguments and asked tough questions in the multistate lawsuit challenging the constitutionality of the federal health reform law and its individual mandate, the Washington Post reports.
The judges are reviewing the Obama administration's appeal of a lower court's ruling that invalidated the entire law. During oral arguments, the judges repeatedly questioned the coverage requirement and indicated that they were not convinced by the administration's defense.
Chief Judge Joel Dubina, who was appointed by President George H.W. Bush, asked the administration if there would be "any limits on congressional power" if the court were to uphold the individual mandate. Dubina also asked Acting Solicitor General Neal Katyal to provide an example in which the U.S. Supreme Court used the Constitution's commerce clause to justify "compelling a private person to purchase a private product."
Former U.S. Solicitor General Paul Clement, who is representing the states, argued that "[i]t boils down to the question of whether the federal government can compel people into commerce to better regulate the individual." He acknowledged that Congress could require uninsured individuals to purchase coverage at the time they need it, but not in advance of such an instance.
Katyal, who previously argued in defense of the law in similar appeals in Ohio and Virginia, said Congress can exercise its power to regulate commerce if it would resolve a national problem, not a local one. He insisted that in this case, Congress is authorized to require health insurance for most uninsured individuals because they shift an estimated $43 billion in medical costs annually to taxpayers.
The judges also asked Clement and Katyal about whether the full overhaul should stand if the individual mandate is struck down. Katyal said it would be a "deep, deep mistake" to invalidate the law. Clement said that the mandate is the "driving force" of the overhaul and that without it, the law should be rescinded.
At the conclusion of the hearing, the judges offered no indication of a timeline for their ruling (Aizenman, Post, 6/8; Sack, New York Times, 6/8; Bluestein, AP/Herald, 6/8; Savage, Los Angeles Times, 6/8; Haberkorn, Politico, 6/8).
How a ‘best doctor’ removes a brain tumor
June 9, 2011
As part of its “Best Doctors” issue, New York magazine included essays and photo slideshows that reveal several of the city’s top physicians at work.
For example, one series of photographs captured a Montefiore Medical Center cardiac surgeon transplanting a baby’s heart, while another slideshow features an orthopedic surgeon at NYU Langone Medical Center amputating a man’s leg. Dr. Phillip Gutin of Memorial Sloan-Kettering Cancer Center—a neurosurgeon who removed a man’s 2.5-cm brain tumor in a five-hour operation (photos)—explained to New York how he slowly vacuums tumors out of the brain, and why his team had to leave part of the tumor behind in this case. Yet Gutin cautions that focusing solely on the “best doctors” misses part of the story; “it’s insane the amount of courage it takes to have your brain operated on,” he notes (New York magazine, 6/5).
IOM: 'Green' buildings may harm health
June 9, 2011
Efforts to make buildings more energy efficient may actually be detrimental to the health of the people who live or work in them, according to a new Institute of Medicine (IOM) report.
According to IOM, these growing efforts have prompted a shift toward using new—and untested—materials and building retrofits that might limit or alter a building's internal air flow. Restricted air flow may cause indoor pollutants, such as chemical emissions and tobacco smoke, to concentrate.
The report also suggests that untested materials and retrofits could foster:
- Indoor dampness;
- Poor ventilation;
- Higher-than-normal temperatures; and
- Emissions from materials and related equipment, such as back-up power generators.
The report notes that climate change also could directly affect indoor air quality, and urges environment regulators to work with other groups to consider such public health concerns when they review and implement new codes and ventilation standards (Pecquet, "Healthwatch," The Hill, 6/7).
Panel approves delay for Stage 2 of meaningful use
June 9, 2011
The Health IT Policy Committee has approved recommendations from its meaningful use work group to delay for one year Stage 2 meaningful use for health care providers attesting to achieving Stage 1 criteria this year.
Adhering to the original timeline of implementing Stage 2 by 2013 "poses a nearly insurmountable timing challenge for those who attest to meaningful use in 2011," according to the work group. The work group added, "With the anticipated release of the final rule for Stage 2 in June, 2012, it would require EHR vendors to design, develop and release new functionality, and for eligible hospitals to upgrade, implement and begin using the new functionality by the beginning of the reporting year in October of 2012."
Under the work group's recommendations, health care providers attesting to Stage 1 criteria this year would have until 2014 to meet Stage 2 requirements. The 2014 deadline for meeting Stage 2 criteria would stand for health care providers who attest to meeting Stage 1 criteria next year. The recommendations were based on seven public hearings, testimony from about 100 individuals, and more than 400 public comments.
CMS is expected to issue a final rule on Stage 2 meaningful use criteria in mid-2012 (Goedert , Health Data Management, 6/8; Mosquera, Government Health IT, 6/8; Conn, Modern Healthcare, 6/8 [subscription required]; Goedert , Health Data Management, 6/8).
Project RED: Three hospitals share secret to reducing readmissions
Model aims to provide discharge support
June 9, 2011
The Wall Street Journal this week highlighted how a handful of hospitals are curbing unnecessary readmissions using the discharge planning program, Project RED, which in some cases assigns patients a virtual advocate to explain follow-up treatments.
Challenges with frail patients, lack of follow-up
According to the Journal, hospital stays are shorter than ever; patients may be discharged in increasingly frail conditions; and some patients are re-admitted shortly after leaving the hospital because they do not understand instructions on how to maintain their own care.
Meanwhile, more than one-third of patients do not receive necessary lab tests, specialist referrals, or follow-up care when leaving the hospital. According to the Agency for Healthcare Research and Quality, 4.4 million hospital stays per year are a result of potentially preventable readmissions, adding $30 billion annually to overall U.S. health care costs.
Project aims to provide discharge support
Project RED (an acronym for "Re-Engineered Discharge") was developed by Boston University and it helped reduce readmissions at Boston University Medical Center by 30% in a 2008 study. Under the program, hospital staff assign each patient a nurse "discharge advocate," who educates the patient about his or her diagnosis, organizes follow-up appointments, and verifies medication plans. The nurse provides an individualized instruction booklet for the patient, which also is sent to the patient's regular physician. The nurse then asks the patient to explain treatment plans in his or her own words, and follows up two days later to troubleshoot problems.
Boston University researchers using the RED program also developed a "virtual discharge advocate" to explain home care to patients. They found that use of a digital avatar—which engages patients using a touch screen—can cut costs. An associate professor at Boston University notes that discharge plans with human nurses cost about $123 per patient and took 81 minutes per discharge, while the virtual discharge system automated 30 minutes of that process and led to $145 in per-patient savings.
Rockledge, Fla.-based Health First utilizes Project RED in three of its four Florida hospitals. In a program that ran from September 2010 to March 2011, congestive heart-failure patient readmissions dropped by 29%, compared with hospital units where the program was not used.
Hospitals also are implementing their own measures to reduce readmissions, the Journal reports. For example, Grove City Hospital in Pennsylvania provides patients with a printout of instructions and information during discharge, in addition to assigning them transition coaches who call two or three days later to discuss medications and appointments. Grove City also offers a "Home with Meds" program that provides patients with a one-month supply of medications and recruits local pharmacists to visit hospitals and counsel patients (Landro, Journal, 6/7).
Senators call for investigation of surgeons
June 9, 2011
Five senators are calling on HHS' Office of the Inspector General (OIG) to investigate physician-owned distributorships (PODs) to determine whether they violate anti-kickback statutes or federal fraud and abuse laws, the Wall Street Journal reports.
Distributorships are "middleman entities" that market and distribute medical devices to hospitals in exchange for a commission on the sale. Accordingly, sales commissions may go to surgeons or physicians if they own the POD. However, surgeons often determine which devices hospitals purchase, allowing those involved in PODs to "steer business to themselves," the Journal reports.
According to a Senate Finance Committee report compiled by Sen. Orrin Hatch's (R-Utah) office, PODs create "financial incentives for physician investors to use those devices that give them the greatest financial return." Citing anecdotal evidence, the report linked PODs—which currently operate in at least 20 states—to an increase in unnecessary surgeries. For example, one hospital's spinal re-operation rate increased by more than 300% after a POD formed in its community.
At least one hospital system already has ceased conducting business with PODs because of such concerns, the Journal reports. According to Stuart, Fla.-based Martin Memorial Health Systems officials, the distributorships are "inconsistent with the spirit and intent of the federal anti-kickback statute." However, one Los Angeles law firm says that PODs are legal, as long as they institute appropriate safeguards. POD defenders also note that distributorships can cut costs, as they usually offer hospitals lower prices than the manufacturer.
Sens. Hatch, Max Baucus (D-Mont.), Herb Kohl (D-Wis.), Charles Grassley (R-Iowa), and Bob Corker (R-Tenn.) have asked the OIG to submit initial findings of the POD investigation by Aug. 12 (Carreyrou, Journal, 6/9).
Around the nation
Bite-size hospital and health industry news
June 9, 2011
Connecticut: Gov. Dan Malloy (D) says he will sign a bill passed last weekend by the state Legislature that mandates paid sick days for certain employees, NPR reports. The bill would grant up to one week of paid sick leave, primarily to service workers at companies that employ at least 50 people. According to a Connecticut Working Families representative, the new law is a public health matter. "Nobody wants the person who is serving their food, driving their kids to school, providing their day care or home health care to be going to work with an illness," he said. Some businesses lobbied against the bill and successfully scaled it back to exclude manufacturing, temporary workers, or independent contractors (Ludden, NPR, 6/6).
Florida: The Brady Center to Prevent Gun Violence has filed a lawsuit in U.S. District Court to block a recently passed state law that bars physicians from discussing gun ownership with patients. Opponents of the law, such as the American College of Physicians and the Florida Pediatric Society, say it encroaches on physicians' freedom of speech rights because it prohibits them from discussing a public health issue. After the lawsuit was announced, the National Rifle Association issued a legislative alert defending the new law, saying it keeps "gun ban politics" out of physicians' offices (Carlson, Modern Physician, 6/6 [subscription required]).
Georgia: A newly enacted law now requires Georgia physicians to disclose to the Georgia Composite Medical Board (GCMB) whether they have medical liability insurance, American Medical News reports. Under the law, the GCMB is authorized to publish the information online as part of a physician's public profile. The physicians also have to inform patients about their coverage if they are asked. Failure to do so could result in disciplinary action by the board (Gallegos, American Medical News, 6/6).
Massachusetts: The ratio of Massachusetts residents who support the state's 2006 universal health care law increased by 10 percentage points over the previous two years, according to a recent Harvard School of Public Health/Boston Globe survey. In 2011, 63% of state residents supported the law, while 21% opposed it. However, opposition to the law's individual mandate increased from 35% in 2008 to 44% (Lazar, Globe, 6/5).
Minnesota: Hospitals statewide generated $27.2 billion for the economy in 2009 and supported more than 200,000 jobs, according to a new Minnesota Hospital Association (MHA) report. MHA's president and CEO says state budget cuts would "compromise our ability to maintain jobs and services and prepare for the growing health care needs of our residents." The report was based on data from the Minnesota Department of Employment and Economic Development (AHANews, 6/7).
Omega-3 fatty acids may lower diabetes risk
June 9, 2011
People whose diets include large amounts of omega-3 fatty acids have a lower risk of developing Type 2 diabetes, according to a pair of studies published in the American Journal of Clinical Nutrition.
One study found that participants with the highest blood levels of eicosapentaenoic and docosahexaenoic acids—which are both omega-3 fatty acids—were about 33% less likely to develop diabetes across the following 10 years, compared with participants with lower levels.
Meanwhile, a second study of individuals ages 45 to 74 found that 20% of participants with the highest levels of alpha-linolenic acid in their diets were less likely to develop diabetes than the 20% who ate the least.
However, researchers cautioned that the findings do not prove that the omega-3 fatty acids fight diabetes (Norton, Reuters, 6/3).
After saving lives, Bahrain physicians face jail for treason
June 8, 2011
Forty-seven health providers in Bahrain accused of attempting to overthrow the monarchy will be tried in a special security court this month, CNN reports.
Many of the workers treated patients at Salmaniya Medical Complex, which the Bahrain government claims served as a coordination point for protesters. According to the justice ministry, the physicians, nurses, and paramedics have been charged for incitement to overthrow the regime, refusal to help patients in need, and deadly assault. However, human rights groups, who accused the government of attacks on medical workers during the protests, say the workers are being tried for providing medical care to protesters. The trial, which was scheduled to begin Monday, has been postponed to June 13 (Fenton, CNN, 6/6; Surk, AP/Google News, 6/6).
Do VA hospitals provide better cancer care than other U.S. facilities?
June 8, 2011
Older men who are diagnosed with cancer and treated at Veterans Health Administration (VHA) hospitals receive equal or better care than male Medicare beneficiaries treated in the private sector, according to a study published in the Annals of Internal Medicine.
Researchers analyzed data from 2001 to 2004 and found that men older than age 65 who received care through the VA were diagnosed with earlier stages of colorectal cancer than Medicare beneficiaries. About 29% of individuals with colon cancer being treated at VHA hospitals were diagnosed during stage 1, compared with 24% of Medicare beneficiaries. VHA patients also were more likely to get surgery for colon cancer, and to receive the recommended treatments for lymphoma and multiple myeloma.
However, Medicare beneficiaries were 40% more likely to undergo new treatments for prostate cancer, which researchers said could reflect slow adoption of new technology by the VHA.
The findings highlight the VHA's focus on preventive and integrated care, according to researchers, who suggest that the system could serve as a "model for health care delivery" as the federal health reform law is implemented. They note that the VHA is the largest U.S. health system, enrolling roughly 6.1 million veterans (Pittman, Reuters, 6/6).
Around the nation:
Bite-size hospital and health industry news
June 8, 2011
Alabama: Gov. Robert Bentley (R) has spearheaded efforts to hasten the state's implementation of a health insurance exchange and ramp up Medicaid expansion under the reform law, despite the state's reputation for being staunchly conservative, Politico reports. Last week, Bentley returned to the state Legislature a budget measure that would have increased Medicaid funding by $7 million, well below his recommendation for a $247 million increase. In addition, he issued an executive order to push forward the state's exchange program. Further, the state's Medicaid director has expressed skepticism about a block grant program—like the proposal in the House GOP fiscal year 2012 budget blueprint—and has expanded the children's health insurance program (Kliff, Politico, 6/6).
California: The Palo Alto City Council on Monday approved Stanford University's hospital expansion project after four years and 96 meetings of "intense" negotiations and debates, the San Jose Mercury News reports. The $5 billion project will expand the university's hospital, clinics, and medical offices by 1.3 million square feet. According to the hospital's ED medical director, current hospital operations are "truly hampered by our current physical plans." The expansion will add 144 beds to Stanford Hospital, 104 beds to Lucile Packard Children's Hospital, and create more private patient rooms. In exchange for project approval, Stanford has committed to a development agreement that includes almost $175 million in community benefits (Samuels, Mercury News, 6/7).
Florida: The sterile processing department (SPD) at Tampa-based H. Lee Moffitt Cancer Center & Research Institute has been named the 2011 SPD Department of the Year by Healthcare Purchasing News. According to the center’s manager of clinical sterile processes, the award reflects "a partnership...[and] mutual respect" between the hospital's operating room and SPD, which has been bolstered by a co-developed service agreement. Moffitt’s SPD also launched a quality improvement initiative that drew from Lean management principles, introduced mandatory certification and a clinical employment ladder for staff, and centralized processing and tracking efforts (Dana Barlow, HPN, May 2011).
Ohio: Cleveland Clinic on Monday announced that it will close Huron Hospital in East Cleveland within 90 days, the New York Times reports. The 211-bed community hospital's closure "reflects a stark new reality" for the hospital industry, which can no longer afford empty beds or unused services, according to the Times. Cleveland Clinic will replace the hospital with the Huron Community Health Center, which will be "better designed to meet the community's changing health needs," a news release said. Cleveland Clinic will offer Huron patients transportation to its other associated hospitals (Abelson, Times, 6/6; Robeznieks, Modern Healthcare, 6/6 [subscription required]).
South Carolina: Medicaid payments to physicians will be cut by up to 7% and beneficiary copayments for physician visits will increase by $1 beginning next month, the Charleston Post and Courier reports. The state Medicaid agency is expected to cut an estimated $125 million overall for the upcoming fiscal year. The new copayments will go into effect on July 1 and the payment cut—which is the second in three months—will take effect on July 8. Physician and hospital associations say the cuts will harm patients and cause more physicians to cease accepting Medicaid coverage (Dudley,Post and Courier, 6/7).
Phoning in results:
Pfizer launches first 'virtual' U.S. clinical trial
June 8, 2011
Pfizer on Tuesday announced the launch of a study that is believed to be the first all-electronic, home-based clinical drug trial to receive FDA approval.
The study is part of an effort by Pfizer and FDA to determine whether technology can make it easier for patients to sign up and participate in clinical trials. For the trial, researchers will attempt to replicate a 2007 study that compared the results of overactive bladder drug Detrol to a placebo.
The new trial will rely on various IT tools instead of traditional research methods. For example, researchers are recruiting participants through online advertisements. In addition, interested parties can learn about the study and enroll via the trial's website.
Trial participants will receive their medication in the mail, and they will need to have their blood drawn at a nearby clinic or during a home visit. Throughout the course of the study, participants will use a mobile phone application to track symptoms of an overactive bladder. In addition, participants will use a secure website to complete online assessments four times during the trial (Corbett Dooren, Wall Street Journal, 6/7).
Giving back $180 million
Why Calif. insurer will cap payments
June 8, 2011
Blue Shield of California on Tuesday announced a plan to cap profits at 2% of revenue and allocate any excess funds as credits to policyholders, funding for health care providers, and grants to not-for-profit health care organizations, the Sacramento Bee reports.
The not-for-profit insurer said it would jumpstart its new plan by distributing $180 million, the amount by which Blue Shield exceeded the 2% profit limit in 2010. Of the $180 million, Blue Shield said it would provide about $167 million to reduce costs for nearly two million policyholders. Under the plan, affected policyholders would see their October premiums decrease by about $80 for individual policyholders, $250 for a family of four, and between $110 and $130 per employee for businesses.
Blue Shield also plans to allocate $10 million of its excess profits to hospitals and physicians participating in programs aimed at improving care coordination, such as launching accountable care organizations. The remaining $3 million will go toward Blue Shield's foundation.
Blue Shield's leaders say they were motivated by the nation's struggling economy and their goal to make coverage affordable. "It represents a paradigm shift for a health plan," Blue Shield's CEO says. "We are setting an example that may challenge others to consider what changes they can make."
Blue Shield's announcement also came as the state's health insurance industry faces increased criticism from lawmakers, consumer advocates, and policyholders over recent rate hikes. In March, Blue Shield canceled the last of three rate increases in seven months following pressure from state Insurance Commissioner Dave Jones (D) and individual policyholders (Smith, Bee, 6/8; Helfand, Los Angeles Times, 6/8; Abelson, New York Times, 6/7; Wilde Mathews, Wall Street Journal, 6/8).
Nursing schools struggle to keep up with demand
June 8, 2011
Although the recent economic recession helped stem the growing shortage of nurses, nursing schools are struggling to keep up with the high demand expected in the next few years, the Washington Times reports.
According to the Times, nursing schools presently are understaffed. As a result, many top-rated nursing programs have turned away hundreds of potential students in the past two years. For example, the University of Minnesota-Twin Cities admitted 64 if 324 total applicants this year. Meanwhile, the University of Washington-Seattle admitted 95 of 455 applicants, and the University of Pittsburgh admitted 120 of 1,050 applicants in 2010.
Joanne Spetz, an associate professor at the University of California-San Francisco and a specialist in health economics, notes that the current lull in the nursing shortage also could cause lawmakers to withdraw funding for nursing schools. Some nursing school officials say that already is happening, the Times reports. Kristen Swanson, dean of the University of North Carolina's (UNC) School of Nursing, said that UNC reduced its undergraduate nursing program by 25% this year, largely because of state funding cuts (Courchane, Times, 6/6).
Study: Millions of U.S. patients do not receive optimal HF therapy
June 8, 2011
Almost 70,000 U.S. residents die each year because they are not given optimal heart failure (HF) therapy, according to a recent study published in the American Heart Journal.
Researchers at UCLA's Geffen School of Medicine compared six evidence-based HF therapies with data from clinical trials, in-patient and out-patient registries, quality-of-care studies, and other sources. The therapies include four families of drugs, cardiac resynchronization therapy, and implantable cardioverter-defibrillators. They are recommended by the American College of Cardiology and the American Heart Association for HF patients.
According to findings, 2,644,800 HF patients were eligible for the therapies but did not receive them. Data show that 67,996 deaths could have been prevented annually with optimal implementation of all six therapies.
Researchers estimated that the number of lives that could have been saved with each therapy is:
- 21,407 lives with aldosterone antagonists;
- 12,922, beta blockers;
- 6,516, angiotensin-converting enzyme inhibitors;
- 6,655, hydralazine/isosorbide dinitrate;
- 8,317, cardiac resynchronization therapy; and
- 12,179, implantable cardioverter-defibrillators.
The findings may "have significant clinical and public health implications," the study's lead author says, noting that they may compel physicians to more carefully consider treatment strategies (Maugh, "Booster Shots," Los Angeles Times, 6/6).
The late shift
Hospitals hire nocturnists to streamline nighttime care
June 8, 2011
More hospitals are hiring "nocturnists"—a subspecialty dedicated to the overnight shift—to circumvent resident staffing constraints and prepare for performance-based Medicare payments, Kaiser Health News/Washington Post reports.
A full-time nocturnist focuses on patients outside of the ED and typically works three or four shifts per week, often from 7 p.m. to 7 a.m. Although they work fewer hours than their daytime counterparts, they often earn higher salaries. According to the Seattle-based physician who coined the term "nocturnist," about 1,500 hospitals currently employ at least one nocturnist, up from fewer than 100 hospitals one decade ago.
The demand for nocturnists is being fueled by the widespread acceptance of inpatient hospitalists—who seek to bolster night coverage—mandatory resident and intern shift limits, and a push by the federal government and other patient advocate groups to improve safety. For example, Joint Commission standards have compelled hospitals to deploy rapid response teams when a patient's condition deteriorates, and the federal health care overhaul next year will begin tying Medicare reimbursement to patient satisfaction scores.
According to a Johns Hopkins Bayview Medical Center nocturnist, patients benefit from more late-night physicians because they can receive treatment immediately. "I can grease the wheels…and move people into the hospital more quickly and efficiently," she says. KHN/Post notes that the hospital has decreased ICU wait times from six hours to 90 minutes by expanding its late-night staff (Boodman, KHN/Post, 6/6).
Consumer Reports rates teaching hospitals on patient safety
June 8, 2011
A recent Consumer Reports Health (CRH) analysis indicates that teaching hospitals and large, renowned medical centers do not consistently score well on certain patient safety measures.
Using data collected by the Leapfrog Group and from state databases that monitor hospital-infection rates, CRH analyzed central-line associated bloodstream infection (CLABSI) rates from more than 1,119 U.S. hospitals. According to CRH, CLABSIs are among the most common hospital-acquired infections and kill up to 25% of patients who contract them.
The researchers found that facilities in the Council of Teaching Hospitals (CTH) reported no improvement in CLABSI rates compared with the year before. Only two CTH hospitals, or 1%, reported no CLABSIs in this year's report, down from four hospitals (2%) in 2010. Overall, 142 facilities, or 12.7% of all hospitals, reported no CLABSIs, up from 105 (11%) the year prior.
Only 36 hospitals maintained zero bloodstream infections across the last two reports and many were small- to medium-sized facilities. "There's a tendency to think of the large urban hospitals as being the best in terms of delivering patient care and safety, but the top performers include many community hospitals that tend to be on the smaller side," says John Santa, director of CRH's Ratings Center.
CRH also found that many teaching hospitals opted not to report infection rates, noting that only about 26% of all U.S. hospitals provided CLABSI data. According to CRH, "there needs to be more pressure from the federal government to require hospitals to report information on bloodstream infections."
Analysis identifies variation within systems
In a companion analysis, CRH identified wide variation on patient safety within hospital systems.
CRH analyzed 61 hospital systems where at least five hospitals publicly reported CLABSI data. They found that many "well-known hospital brands" posted worse CLABSI rates than the national average. According to Santa, the study's "big takeaway" is that consumers "can't judge a hospital's commitment to patient safety based on the flagship hospital" (CHR, 6/7; CHR, June 2011; CHR release, 6/7; McKinney, Modern Healthcare, 6/7 [subscription required]).