The Daily Briefing

News for Health Care Executives

How Sentara nearly doubled hand hygiene compliance

Virginia health system increased hand washing with several interventions

March 5, 2012

Pop quizzes and notes on white boards in patients' rooms saying "I like clean hands" helped one Virginia health system improve workers' hand-washing rates from about 50% to 92.5%, American Medical News reports.

Although Sentara Healthcare System already made sanitizer foam and sinks easily accessible to staff, the organization—like many health systems—was prompted by pressure to further improve its hand-hygiene rates.

Notably, Sentara officials realized that the staff hand-washing compliance rate was about 75%—and not the 95% that they previously believed. Nosocomial infections are being publicly reported and many insurers do not provide payment to treat some that are acquired while patients are admitted.

Seeking improvement, Sentara last summer convened 83 staffers to brainstorm solutions for boosting hand-washing rates and curbing infections.

The group came up with a list of quick and inexpensive ideas, ranging from computer screensavers to "Hero of the Month" awards. These initiatives were then tested in different combinations by a consulting firm in 48 of the seven-hospital system's units over six weeks.

Ultimately, the health system found that in addition to white-board notes and random hand-hygiene pop quizzes from Sentara leaders, putting up red stop signs to remind workers to clean their hands was effective (O'Reilly, American Medical News, 2/29).

Illinois again asks if hospitals deserve tax-exempt status

Hospitals, officials fail to reach agreement on requirements

March 5, 2012

Gov. Pat Quinn (D) has told the Illinois Department of Revenue to resume its reviews of hospitals' tax-exempt status, following failed negotiations to define new charity care requirements.

Quinn in September ordered the revenue department to halt its decisions on whether not-for-profit hospitals could keep their tax-exempt status, after the Illinois Hospital Association (IHA) and its members protested the department's decision to deny tax exemptions for three hospitals over their charity care levels.

Under the governor's order, hospitals and state officials had until March 1 to reach an agreement on hospital tax-exemption requirements and the definition of charity care. But the Chicago Tribune reports that talks reached an impasse on Feb. 29, prompting Quinn to lift the review moratorium.

As a result, the revenue department will resume reviews on pending tax-status applications from 18 not-for-profit hospitals. Department officials say they expect to issue new rulings next month.

IHA President Maryjane Wurth expressed surprise at Quinn's decision. She warned that new rulings would present "a distraction from the work that needs to be accomplished in developing a legislative solution over the next three months of the General Assembly's spring session."

According to IHA, the state should expand its definition of charity care to include patients' unpaid debts, the costs of elderly patient services not covered by Medicare, Medicaid patient services, and the costs teaching hospitals incur to train physicians and conduct research (Forst, Chicago Tribune, 3/1; Selvam, Modern Healthcare, 3/1 [subscription required]).

Many women are hour away from maternity care

Study finds wide variation in access to hospital maternity services

March 5, 2012

Many women living in rural, Western states must drive for more than an hour to reach a hospital that provides maternity care, according to a study in Obstetrics & Gynecology.

Overall, more than 97% of women ages 18 to 39 live within a one-hour drive of a hospital that provides at least basic maternity and nursery care. Moreover, 80% of women live less than an hour away from a hospital with resources for handling complicated deliveries, such as a neonatal ICUs.

Do you live in a state with easy access?
More than 99% of women in the Northeast live within a one-hour drive of maternity services, with the vast majority living within a 30-minute drive. The top five states for access were:

  • Indiana (99.9% of women lived within 60-minutes of maternity care);
  • Ohio (99.9%);
  • Pennsylvania (99.9%);
  • Rhode Island (99.9%); and
  • Iowa (99.8%)

However, women in Western, non-costal states with lower population densities had less easy access to care. The bottom five states were:

  • Alaska (62.8%);
  • Montana (68.1%);
  • New Mexico (83.1%);
  • Wyoming (84.2%); and
  • North Dakota (84.2%)

According to the study, there is no consensus on the "optimal distribution" of hospitals with maternity and newborn services. "[I]deally, no woman should have to drive more than an hour," says the University of New Mexico's William Rayburn, who led the study.

Rayburn suggests greater use of telemedicine to allow physicians at larger hospitals to advise physicians at smaller facilities on complicated cases (Norton, Reuters, 3/1).

CMS quality reporting program didn't improve mortality rates

'Jury's still out' on Hospital Compare's quality impact

March 5, 2012

CMS' Hospital Compare website—which began publicly reporting hospital care quality data seven years ago—has had no impact on mortality rates for myocardial infarctions (MIs) or pneumonia, according to a study in Health Affairs.

CMS in 2005 began posting quality ratings for more than 3,000 U.S. hospitals on its Hospital Compare website. The site first included data on adherence to basic clinical care guidelines and expanded to include patient experience scores, readmission rates, mortality rates, and complication rates.

Based on Medicare claims data from 2000 to 2008, Weill Cornell Medical College researchers and colleagues found that hospitals may have reduced 30-day mortality for MIs and pneumonia over the seven-year study period. However, the researchers, who also assessed Hospital Compare site usage, attributed that improvement to ongoing clinical care innovation rather than public reporting.

The researchers also found a modest improvement in heart failure 30-day mortality rates, but could not determine whether the improvement could be attributed to public reporting efforts. In addition, the researchers determined that the Hospital Compare website did not direct patients toward hospitals with better quality ratings.

"The jury's still out on Medicare's effort to improve hospital quality of care by posting death rates and other metrics to a public website," says lead author Andrew Ryan. He recommends further study on the impact of public reporting on care quality (Fleming, Health Affairs release, 3/6; Rau, "Capsules," Kaiser Health News, 3/5; McKinney, Modern Healthcare, 3/5 [subscription required]).

Hospital CIOs turn to outside consultants for advice

Nearly 50% of hospitals have hired—or plan to hire—IT consultants

March 5, 2012

Nearly one in two hospital CIOs plans to hire outside consultants to help them achieve meaningful use of electronic health records and manage other health IT initiatives, according to a survey by healthsystemCIO.

According to survey responses from healthsystemCIO's CIO Advisory Panel, 46% of hospital CIOs say they already have spent or plan to spend a "significant amount" of money to hire consultants. Meanwhile, 54% say they plan to leverage internal resources instead of hiring consultants.

Of the CIOs who intend to hire consultants, 62% say that their institutions lack the resources or expertise necessary to complete IT projects without outside assistance. Morevoer, 69% of hospital CIOs say they do not think they will have more difficulty securing funds to hire consultants than securing funds for software investment.

The survey also found that 58% of hospital CIOs believe that smaller organizations are at a disadvantage for qualifying for meaningful use incentives because of their limited ability to hire consultants (healthsystemCIO survey, 3/1).

About the Meaningful Use Navigator
Across the past several months, The Advisory Board Company’s Meaningful Use Navigator has helped a select group of hospitals prepare to receive roughly $90 million in meaningful use hospital incentive payments. One takeaway: even the most advanced organizations can get tripped up on preparing for Stage 1 and Stage 2.

Millions of patients deal with lingering medical debt

More than 3M Americans plagued by paid-off medical debt

March 5, 2012

Medical bill collections can lower a patient’s credit score for years, even if the bill was caused by a misunderstanding and after it has been paid off, the Associated Press reports.

Collection agencies, which now handle late bills for most hospitals and physicians, are allowed to keep records of medical debt on file for seven years. The agencies currently maintain the records of nearly 3.4 million U.S. residents whose medical debts already have been paid, according to a report by the Access Project.

Medical bills account for the majority of collection cases that appear on credit reports, and most are for less than $250, according to the Federal Reserve Board. About 30 million U.S. residents were contacted by debt collection agencies for unpaid medical bills in 2010, up from 22 million in 2005, the Commonwealth Fund has found.

To address the issue, Congress is the Medical Debt Responsibility Act, which would give credit agencies 45 days after they have been paid to delete records of medical debt from consumers' credit reports (Johnson, AP/Sacramento Bee, 3/4).

Study: Moving—even in small doses—is crucial to health

Scientists try to quantify risks of sedentary behaviors

March 5, 2012

Reducing your physical activity for just three days is enough to trigger higher blood-sugar levels, according to a new study.

For the study, published in Medicine & Science in Sports & Exercise, University of Missouri researchers adopted a novel approach to measuring the effects of sedentary behavior: They persuaded a group of healthy young adults to stop moving around so much.

During the three-day inactivity period, participants' blood sugar levels spiked progressively higher after meals, reaching about 26% greater than normal. Because participants were told to eat the same meals and snacks throughout the study, the researchers attributed the changes in blood sugar levels directly to inactivity.

According to study author John Thyfault, blood spikes from inactivity only pose a serious concern when it becomes the body's default condition. "We hypothesize that, over time, inactivity creates the physiological conditions that produce chronic disease," like Type 2 diabetes and heart disease, regardless of a person’s weight or diet, he said.

The study reinforces the value of exercise guidelines from the American Heart Association, according to the New York Times, which recommend that individuals accumulate 10,000 steps or more per day for optimal health. However, repeated studies have shown that the average U.S. adult takes fewer than 5,000 steps per day (Reynolds, "Well," New York Times, 2/29).

Daily roundup: March 5, 2012

Bite-sized hospital and health industry news

March 5, 2012

  • California: State Sen. Sam Blakeslee (R) last week introduced two bills intended to reduce violence at California's five state mental hospitals. The bills would require specialists to review the addiction histories of defendants who pleaded not guilty by reason of insanity and would make an assault on hospital staff an automatic felony for certain patients (Romney, "L.A. Now," Los Angeles Times, 3/1).
  • Florida and Georgia: Mayo Clinic Jacksonville has agreed to acquire Satilla Health Services, a 187-bed hospital in Waycross, Ga. The acquisition would establish the Clinic's first presence in Georgia (Kutscher, Modern Healthcare, 3/1 [subscription required]).
  • Michigan: The University of Michigan Health System (UMHS) last week reached an affiliation agreement with Trinity Health-Michigan, a 14-hospital system. The affiliation will focus on pediatric care, oncology, and care for seriously ill patients. According to a UMHS statement, the deal "positions UMHS and Trinity-Michigan to take advantage of federal and state programs" that incent systems to improve care coordination and cost control (Evans, Modern Healthcare, 3/1 [subscription required]).
  • Oregon: Gov. John Kitzhaber (D) on Friday signed into law a state health reform bill that establishes new "coordinated care organizations" for Oregon Health Plan enrollees. The new organizations will focus on prevention and integration of medical, dental, and mental health services.  According to the Oregonian, the bill represents "the keystone of the governor's health care package" (Cole, Oregonian, 3/2).

Need some coffee, doc?

Physicians among America’s most sleep-deprived jobs

March 5, 2012

Physicians are among the nation's top 10 professions that get the least amount of shut-eye, according to a recent survey.

For the study, the mattress store Sleepy's hired researchers to rank the most sleep-deprived workers in the United States. The list was based on interviews from 27,157 adults who participated in CDC's National Health Interview Survey, which asked respondents their occupations and how many hours of sleep they typically logged in a 24-hour period.

The study found that workers in the following occupations slept the least:

  • 1. Home health aides;
  • 2. Lawyers;
  • 3. Police officers;
  • 4. Physicians, paramedics;
  • 5. Economists;
  • 6. Social workers;
  • 7. Computer programmers;
  • 8. Financial analysts;
  • 9. Plant operators; and
  • 10. Secretaries.
  • Meanwhile, the results showed that people who were forest, logging workers, hairstylists, and sales representatives were the most well-rested (Rampell, "Economix," New York Times, 2/22; Tuttle, "Swampland," Time, 2/24).

    Weekly review

    Key articles from Feb. 27-March 2

    March 5, 2012

    Missed a day of the Daily Briefing? Here's a quick round-up of top stories and research highlights from last week’s issues.

    When 'Center of Excellence' status goes wrong (Feb. 29)

    A tragic case in Florida should remind hospital leaders: It's not enough to earn "Center of Excellence" status. You have to vigilantly maintain your excellent standards, too.

    Gallup names healthiest U.S. states (Feb. 28)

    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.

    Physician charged in record $375M Medicare, Medicaid scam (Feb. 29)

    The Obama administration last week announced that a Texas physician and six others were arrested for allegedly defrauding Medicare and Medicaid of nearly $375 million.

    Investigation: Unclean surgical tools a 'hidden threat' in ORs (Feb. 27)

    Dirty medical instruments are used during surgeries at hospitals and outpatient surgery centers "with alarming regularity," the Center for Public Integrity's iWatch News reports.

    Five hospitals receive first palliative care certifications (Feb. 28)

    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.

    Health care CEO turnover outpaces other industries (Feb. 29)

    Twenty-five health care CEOs left their posts in January 2012, up from just nine in January 2011, according to a recent report.


    Engage physicians in advancing key organizational goals

    March 5, 2012

    Develop a blueprint for engaging your organization's unique medical staff. Join us on Mar. 19 for a unique roundtable session leveraging the Advisory Board Company's comprehensive solution set for driving and sustaining physician engagement.


    130 million U.S. residents go without dental insurance

    The U.S. is facing a "dental crisis" and needs to increase access to dental care, according to a report released on Wednesday by Sen. Bernard Sanders (I-Vt.), The Hill's "Healthwatch" reports.

    The report, which Sanders presented to the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging, found that more than 130 million U.S. residents lack dental insurance, more than 47 million live in areas with limited access to dental care, and just 45% of U.S. residents ages two and older went to a dental office in the previous year.

    The report notes that poor dental health can increase the risk of developing diabetes and heart disease.

    According to the report, lawmakers should enact provisions to help increase the number of dental providers and expand Medicaid's dental coverage to include adults. Sanders also recommended including oral health care programs in the federal health reform law and increasing payment rates to motivate dentists to accept Medicaid (Pecquet, "Healthwatch," The Hill, 2/29; Norman, CQ HealthBeat, 2/29 [subscription required]).