The Daily Briefing

News for Health Care Executives

Reinvigorate your inpatient care coordination infrastructure

August 8, 2011

Significant funding at stake for care transitions
The financial implications—both on the upside and downside—outlined in the Patient Protection and Affordable Care Act (PPACA) have ignited a "burning platform" in care coordination.

  • First, the Readmissions Reduction Act proposes to penalize hospitals for excessive 30-day readmissions for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. In FY 2013, hospitals stand to lose up to 1% of total Medicare operating payments.
  • Secondly, the Act offers financial support to assist hospitals in the highest tier of readmission rates for those three conditions through the Quality Improvement Program and the Community-Based Care Transitions Program, which allocates $500 million in funding to improve care coordination for high-risk Medicare beneficiaries. The signal value of this funding cannot, and should not, be overlooked by hospitals.

Hospitals currently plagued by poor care coordination
The increased scrutiny on care transitions is largely driven by the unnecessary costs and poor outcomes attributed to substandard coordination. In response, hospital administrators are immediately focusing on improving continuity of care in the outpatient setting, but as a result, are neglecting to address the lower hanging fruit in the inpatient setting. Moreover, fixing the systemic communication problems in the acute care realm, such as lack of interdisciplinary care planning and prolonged length of stay (LOS), is a pre-requisite to addressing the larger problems in the outpatient setting.

Given the focus on the acute care setting, the Clinical Advisory Board will present a live webconference on “Reinvigorating Inpatient Care Coordination Infrastructure.” In this presentation, the first suite of tactics examines the systemic problems that hinder care coordination in the inpatient setting along with best practices in hardwiring inpatient care team communication. The next series of tactics highlight a critical aspect of the inpatient stay crucial to care coordination, discharge planning. These strategies aim to simultaneously reduce LOS and unnecessary rehospitalization by preparing the patient for a safe handoff from the hospital to the next site of post-acute care.

Learn more
Clinical Advisory Board members may register now for the live webconference, “Reinvigorating Inpatient Care Coordination Infrastructure,” on August 10 at 1 p.m. EST. Daily Briefing readers with questions about the Clinical Advisory Board may email


What AA+ status means for health care

August 8, 2011

After Standard & Poor's (S&P) on Friday downgraded the U.S. credit rating for the first time in history, experts warn that government-funded programs like Medicare and Medicaid—and consequently, hospital credits—could take a hit.

Last week's debt deal calls for House and Senate leaders to establish a 12-member bipartisan, bicameral panel to develop and pass by the end of November a package of $1.5 trillion in additional federal spending cuts over 10 years. Failure by Congress to enact further spending reductions at the end of this year would trigger a series of automatic cuts of as much as $1.2 trillion. If the triggers are engaged, Medicaid is exempted and Medicare is protected from deep spending cuts. However, the deficit panel is not bound by those stipulations.

S&P in its report reclassified the U.S. credit rating from AAA to AA-plus, despite last week's budget agreement. S&P partly attributed the downgrade to the controversial budget debate and ongoing partisan conflict, saying the new panel likely will be subject to another "contentious and fitful process."

The report noted that, although the panel is charged with cutting $1.5 trillion, S&P hopes to see $4 trillion in total deficit reduction. The report also stated that cutting entitlement programs is "key to long-term fiscal sustainability," adding that the debt deal "envisions only minor policy changes on Medicare."

However, a former GOP budget aide says the credit downgrade may prompt lawmakers to think, 'Wait a minute—we've got to make these things work." He noted, "Most people will say they expected this committee to go to loggerheads and nothing will come out of it, but I believe that this will put pressure on the leaders to rethink who they appoint … in a way that they might be willing to work in the center of the political spectrum."

States face downgrades
Fifteen states—including Maryland, New Mexico, South Carolina, and Tennessee—are at risk of losing their AAA rating, which could increase local governments' borrowing costs and prompt further cuts, the Wall Street Journal reports. According to analysts, the U.S. downgrade could cause the federal government to drastically cut spending to states, which then would face even more acute budget constraints for locally-administered programs, like Medicaid.

Hospital credits also could be at risk if Medicaid spending is slashed, Reuters/MSNBC reports. "The degree of dependence on the federal government now becomes a state credit issue," according to a managing principal at eBooleant Consulting, an investment consulting firm. Reuters/MSNBC notes that investors sold off health care stocks last week amid fear that the government would curb spending for the sector (Pear, New York Times, 8/7; CQ Today, 8/5 [subscription required]; Lorber, CQ Today, 8/7 [subscription required]; McKinnon et al., Wall Street Journal, 8/6; Corkery/Murray, Wall Street Journal, 8/6; Bansal/Wilchins, Reuters/MSNBC, 8/7 ).

You're fired?

Should physicians ban unvaccinated patients?

August 8, 2011

As physicians nationwide grapple with parents who are unwilling to vaccinate their children, some have decided to "fire" unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians' medical advice, Time's "Healthland" reports.

Despite reassurance from public health officials that the benefits of vaccinations outweigh the possible side effects, some parents continue to obtain immunization exemptions for their children based on medical, philosophical, or religious reasons. As a result, less than 1% of children between the ages of 19 and 35 months are unvaccinated, recent CDC data show.

According to Austin, Texas-based pediatrician Ari Brown, "hot pockets" of unvaccinated children have emerged in certain communities. "Birds of a father flock together," she says, adding that "those kids attend the same preschool or charter schools—which leaves them at very high risk for vaccine preventable disease epidemics." The clusters also weaken the "herd immunity" made possible by mass vaccination, leaving infants who are too young to receive vaccines vulnerable to an outbreak, the Chicago Tribune reports.

In response, some physicians have decided to reject patients whose parents refuse to vaccinate them. Earlier this year, the Northwestern Children's Practice, an eight-physician practice in Chicago, sent a letter and email to parents announcing that the group no longer would accept patients who refused to follow the childhood immunization schedule. Between June—when they implemented the change—and July, the practice lost fewer than one dozen families, the Tribune reports.

Brown, who also rejects unvaccinated patients, says the decision to not immunize a child is "one of several differences of opinion," adding that she would not be "able to adequately provide care for a patient when their parent clearly does not respect" her medical advice. Another physician whose practice enforces a vaccine policy notes that allowing unvaccinated patients into the physician's office can put other patients at risk. "We have newborns, we have pregnant moms, we have kids with cancer who are immune-compromised, and it is a risk for them to have people coming in who have not been vaccinated" (Rochman, "Healthland," Time, 8/4; Shelton, Chicago Tribune, 7/6).

On the rebound: Hospitals again add jobs in July

August 8, 2011

After a dismal June report on hospital job growth, facilities once again added jobs in July, beating expectations for the sector, according to the latest Bureau of Labor Statistics (BLS) data.

BLS' employment report for June showed that although overall health care employment rose by 13,500 jobs, hospitals lost about 4,000 positions. Citing the lower jobs figures, the Wall Street Journal warned that health care "is starting to come under pressure" because of the weak economy, state budget cuts, and the uncertain effects of health care reform, forcing hospitals and health systems to slice spending. According to a managing director and analyst at Standard & Poor's, these fiscal pressures prompted hospitals to hold onto more cash, which likely slowed employment growth.

However, according to seasonally adjusted preliminary BLS data released on Friday, hospitals in July added 14,000 jobs—a 0.03% increase over June. According to AHA News, without the seasonal adjustment, hospitals in July employed more than 4.7 million people, about 76,800 more than one year ago.

Meanwhile, the health care sector added 31,300 jobs in July, up 0.2% from the month prior. Specifically, ambulatory care added 14,100 positions, physician's offices added 6,300 jobs, and nursing and residential care facilities added 3,200 jobs. Across the past 12 months, overall health care employment grew by 2%, expanding by about 298,800 jobs, Modern Healthcare reports.

According to the BLS data, the U.S. economy added 117,000 non-farm jobs in July, causing the overall unemployment rate to dip to 9.1% (Carlson, Modern Healthcare, 8/5 [subscription required]; AHA News, 8/5; Hobson, "Health Blog," Wall Street Journal, 8/5).

Meaningful payments

Official: Meaningful use program has given out $400M in incentive pay

August 8, 2011

A CMS official recently announced that Medicare and Medicaid have distributed a combined total of about $400 million in meaningful use incentive payments, Modern Healthcare reports.

During a meeting of the Health IT Policy Committee, Robert Tagalicod—director of CMS' Office of eHealth Standards and Services—said about 77,000 health care providers have registered for the Medicare and Medicaid electronic health records (EHR) incentive programs.

Twenty-three states have opened their Medicaid EHR incentive programs for registration. Tagalicod noted that more than 3,500 health care providers already have received incentive payments through Medicaid.

In addition, Tagalicod said 100 hospitals and 2,383 eligible health care providers have attested to meeting the meaningful use requirements under the Medicare EHR incentive program. However, Tagalicod said that 137 health care providers attested unsuccessfully. He did not provide a reason for the failed attestation.

According to Tagalicod, CMS has found that health care providers participating in the incentive programs on average met or exceeded thresholds for demonstrating meaningful use of EHRs. However, he said CMS is taking a cautious approach to the incentive program data. He said it might be "too early to draw conclusions" because early EHR adopters might have more experience with health IT than later adopters (Conn, Modern Healthcare, 8/4 [subscription required]; Mosquera, Government Health IT, 8/4).

Quality fix

Pneumonia-related hospital deaths plummet

August 8, 2011

Pneumonia-related hospital deaths decreased by 45% between 2000 and 2007, according to an Agency for Healthcare Research and Quality (AHRQ) report released last week.

The report found that the average U.S. death rate linked to pneumonia in hospitals fell from 74 deaths per 1,000 admissions in 2000 to 41 deaths per 1,000 admissions in 2007. The statistics included data for individuals older than 18 years of age, including Medicare beneficiaries.

According to the report, Arizona had the lowest pneumonia death rate in 2007, followed by Maryland. However, eight states—Arkansas, Hawaii, Nebraska, New York, Oklahoma, Vermont, West Virginia, and Wyoming—reported having 50 or more deaths per 1,000 readmissions in 2007. Nebraska had the highest pneumonia death rate in 2007 with 57 deaths per 1,000 admissions, the report said.

A medical officer at AHRQ said the decline may be attributable to better inpatient pneumonia care. For example, CMS, the Joint Commission, and the Infectious Disease Society of America in 2001 established goals for improving pneumonia care. Specifically, CMS has recommended that physicians administer antibiotics within six hours of hospital arrival, obtain blood culture results prior to prescribing antibiotics, and determine whether a patient has received a pneumonia vaccine (Norman, CQ HealthBeat, 8/4 [subscription required]; Fox, National Journal, 8/4 [subscription required]).


Getting smarter

CMS unveils website, new quality initiatives

August 8, 2011

CMS on Friday announced new initiatives and Web-based tools to help consumers make more informed choices about their health care, Health Data Management reports.

The new tools and initiatives are:

  • The Quality Care Finder, an online platform that provides access to all Medicare Compare websites that offer information on the quality of hospitals, nursing homes, and health plans; 
  • An updated Hospital Compare website, which offers new data on hospital outpatient surgery infection rates and treatment of outpatients with suspected myocardial infarctions; and 
  • An enhanced Quality Improvement Organization program that aims to provide technical assistance and resources to help health care providers change care delivery.

CMS Administrator Donald Berwick said the new initiatives and Web tools demonstrate "new ways CMS is making sure consumers have information about health care quality and important information they need to make the best decisions about where to receive high quality care" (CMS release, 8/4; Goedert, Health Data Management, 8/5).

Raising the bar

Woman in labor completes law exam, gives birth two hours later

August 8, 2011

A recent Northwestern University Law School graduate completed the Illinois bar exam this summer despite going into labor at the beginning of the exam's final three-hour section, the Chicago Tribune reports.

The 29-year-old test taker began having contractions every 20 to 30 minutes as she started the section but assumed she was in the early stages of labor and would finish the exam before giving birth. After rushing to finish the test, the proctor allowed the woman to leave the testing room early at 4 p.m.

She immediately walked to Northwestern's Prentice Women's Hospital about one block away and delivered a baby boy by Caesarean section at 5:58 p.m. The woman expects to find out if she passed the bar exam in early October (Cohen, Tribune, 8/3).

Daily roundup: Aug. 8, 2011

August 8, 2011

  • Arkansas: A massive fire last week consumed a historic hospital and more than 100 buildings near Fort Smith. The fire started on the grounds of the World War II-era Fort Chaffee medical complex on Wednesday, the hottest day recorded in the city's history. Fort Chaffee at one time was a processing center for Vietnam War refugees, and more recently, housed Hurricane Katrina evacuees. The complex also has appeared in various movies, including "Biloxi Blues." According to the executive director of the Fort Smith Convention and Visitors Bureau, "[t]he hospital…was a structural record of what military medical care here used to be like" (Parker, Reuters, 8/4).


  • Michigan: Reps. Dave Camp (R-Mich.) and Fred Upton (R-Mich.) on Thursday sent a letter to HHS Secretary Kathleen Sebelius in support of their home state's request for a temporary waiver from the medical-loss ratio provision in the federal health reform law, Modern Healthcare reports. The MLR requirement requires private insurers to spend at least 80% in the individual market or 85% in the group market of their premium dollars on direct medical costs. Insurers who do not comply with the ratio will have to issue rebates to consumers. Camp, chair of the House Ways and Means Committee, and Upton, chair of the House Energy and Commerce Committee, wrote, "Based on 2010 data, only two of the seven health plans [in Michigan] would be able to meet the 80% MLR threshold." They added that if the state was forced to comply with requirements, the seven plans would have a net estimated loss of $30.9 million in 2010 (Zigmond, Modern Healthcare, 8/4 [subscription required]; Adams, CQ HealthBeat, 8/4 [subscription required]).


  • Texas: Potential Republican presidential candidate and Texas Gov. Rick Perry for the past two months has been laying the groundwork for the commercialization of adult stem cell therapy in Texas. Texas lawmakers recently passed a measure that authorized the creation of an adult stem cell bank, which Perry signed. A month later, Perry underwent an experimental stem cell procedure in which his own stem cells were injected into his spine and bloodstream. According to the Texas Tribune, Perry then sent a letter to the Texas Medical Board espousing the economic and life-altering potential of adult stem cells and asked the members to recognize the "sound science and good work that is already being done." In addition, Perry has urged the medical board to hold meetings about progressing stem cells use in the state (Ramshaw, Texas Tribune, 8/4; Camia, "On Politics," USA Today, 8/4; Maslin Nir, New York Times, 8/4).


  • Virginia: Norfolk-based Sentara Healthcare last week opened the new 160-bed, $180 million Sentara Princess Anne Hospital in Virginia Beach. According to WAVY, the hospital now will deliver all infants born in the city, taking the place of Sentara Virginia Beach General Hospital. However, Sentara Virginia Beach will retain its trauma and complex care roles, a news release said (WAVY, 8/4).

Living alone after MI ups patients' death risk

MI survivors have a 35% greater risk of dying within the first four years if they live alone after the episode and have limited social support while they recuperate, according to a recent study in the American Journal of Cardiology.

The study's researchers found that after factoring in numerous differences between patients, such as gender, race, marital status, and pet ownership, one-third of the patients who did not live alone had healthy BMIs, compared with one-fifth of those who lived alone.

The patients who lived alone also tended to be older and were two times more likely to be smokers, the study found, noting that with a lack of social support, those patients did not have the encouragement to exercise, take their medication, or make their regular physician's appointments (Bond, Reuters, 8/3).