Did The CDC's Laxness On One Infection Help Spread Another?

Michael Millenson

Posted 10/25/14 on The Health Care Blog

There’s an infection that afflicts thousands of Americans yearly, killing an estimated one in five of those who contract it, and costs tens of thousands of dollars per person to treat. Though there’s a proven way to dramatically reduce or even eliminate it, the Centers for Disease Control and Prevention (CDC) inexplicably seems in no hurry to do so.

Unlike Ebola, this infection isn’t transmitted from person to person, with the health care system desperately racing to keep up. Instead, it’s caused by the health care system when clinicians don’t follow established anti-infection protocols – very much like what happened when Texas Health Presbyterian Hospital encountered its first Ebola patient.  That hospital’s failure flashes a warning sign to all of us.

Employers Can Take an Active Role in Patient Safety

The Patient Safety Movement, an organization comprising leaders from the patient, provider, and medical technology communities, has an ambitious goal of zero preventable deaths by the year 2020. To this end, the group has issued a list of patient safety solutions, which were developed in collaboration with clinician stakeholders and the Joint Commission Center for Transforming Healthcare.

The latest results of the Leapfrog Group’s annual survey on patient safety – coupled with the release of the Emergency Care Research Institute’s top 10 patient safety concerns – make even more relevant the PSM’s directions. Although each group has a slightly different agenda, they both agree that the success of their programs can be enhanced if all stakeholders, including employers, are involved.

Employer action on the patient safety issue could include crafting health benefit plans that reward safety and penalize non-compliance, urging hospital boards to make safety a priority (such as encouraging them to participate in data gathering and implementing safety measures), linking philanthropy to performance and distributing patient safety literature.

Read more here.

New Leapfrog Group Tool Helps Purchasers Calculate Cost of Hospital Errors

Slightly more than a year after the Leapfrog Group unveiled its letter grades for hospital safety, the employer-driven not-for-profit organization has introduced an online tool to help purchasers calculate the annual costs of hospital errors, accidents and infections. The hidden surcharge calculator, developed by a team of experts in patient safety, hospital finance, and policy, is designed to allow employers to determine how much they pay each year in unnecessary medical-related costs.

By inputting claims data and local hospital safety rankings, purchasers are able to calculate both the total surcharge for hospital errors and the average amount spent on errors per patient admission each year. Leapfrog estimates that a purchaser pays, on average, $7,780 in hidden surcharges when a patient is admitted to a hospital with a safety score of “C,” “D” or “F.” The calculator includes an example of an employer with 1,000 annual hospital admissions that would pay a $7.7 million surcharge for the year.

Several NBCH coalition members are Leapfrog Regional Rollout Leaders and active in publishing hospital safety data for use in their markets.

Study: Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality

A new study in the current issue of JAMA Surgery finds little relationship between a hospital’s patient satisfaction scores and most quality ratings. The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. Patient satisfaction was determined by the results of standard Medicare surveys given to patients after they left the hospital. Quality was judged by how consistently surgeons and nurses followed recommended standards of care, such as giving antibiotics at the right time and taking precautionary steps to avert blood clots. The researchers also looked at how hospital employees evaluated safety attitudes at their hospital.

Previous studies of the relationship between patient views and the quality of care also have found that they are not necessarily correlated, but Medicare views them as useful. The patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare’s “value-based purchasing” program, which was created by the Affordable Care Act.

Some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonuses and penalties this year. Hospitals can gain or lose 1 percent of their regular Medicare payments under the quality program. All those individual scores are available to the public on Medicare’s Hospital Compare.

The researchers found that there was some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients and felt their work environment was not excessively stressful. There was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture, which also included job satisfaction, working conditions and perception of management.

Hospital Begins Publishing Detailed Patient Safety Information

According to the Boston Globe, Brigham and Women's Hospital has begun an ambitious effort to openly recount patient safety mistakes, and the improvements they led to, in a monthly online newsletter for its 16,000 employees. Brigham leaders started the publication to encourage staff to talk openly about their mistakes and propose solutions, and help make sure errors are not repeated.

While many hospitals post information on their websites about patient infections and falls, they rarely provide details of medical errors or candidly discuss with their entire staff how medical mistakes harmed patients. Executives fear the public will find out, sparking lawsuits and scaring off patients. This reluctance, patient safety advocates warn, may be hampering the push to reduce medical errors because there is not wide discussion of how mistakes happen and can be prevented.

The Brigham doesn’t make the newsletters readily available to the public — but it doesn’t hide them either; it gave the Globe all issues. The Brigham began publishing “Safety Matters” online in January 2011 on its employee intranet and will start distributing paper copies in staff lounges, conference rooms, and other gathering spots later this spring — a move that some hospital administrators initially opposed because they worried about scaring patients. Most issues tell a story of medical care gone awry through interviews with caregivers and often with patients, and describe the hospital’s response. Patients are not named, to protect their privacy. Caregivers also are anonymous because hospital leaders do not want to discourage them from reporting problems.

New and Updated Data on WhyNotTheBest.org

Updated and expanded performance data on measures of patient safety and health care quality are now available on The Commonwealth Fund's dedicated website, WhyNotTheBest.org. The new data, for measures developed by the Agency for Healthcare Research and Quality, come from hospitals in 16 states (including the four newly added states of Massachusetts, Nevada, Oklahoma, and Virginia) and are based on reports from all payers—Medicare, Medicaid, and private insurers. WhyNotTheBest.org is a unique source for exploring these data across states and regions.

In particular, new measures have been added to the following data sets:

• inpatient quality indicators, which track mortality and utilization rates for various conditions; 
• patient safety indicators, which track potentially avoidable complications and adverse events; and 
• prevention quality indicators, which measure hospital admissions that might have been avoided with better medical care outside of the hospital.

Why the U.S. health care system is failing us and how to change it

Here are two new books worth checking out...

Catastrophic Care: How American Health Care Killed My Father–and How We Can Fix It
David Goldhill, a member of the board of directors of The Leapfrog Group and president and CEO of GSN, has written a new book looking at our health care system and why it is failing, why expanding coverage will actually make things worse, and how our health care can be transformed into a transparent, affordable, successful system.

The Incentive Cure: The Real Relief for Health Care
Francois de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3), has just released a new eBook to shed light on one of the toughest issues facing our country, fiscally and socially, asking the critical questions about why patients often don’t get the right care, why America spends twice as much per person as the next biggest spender, and why the rules that apply to every other industry don’t apply to health care? The book also provides answers to many of the questions around why the U.S. health industry fails and highlights some of the most promising ideas for change.

Consumers Use Rankings, But Experts Disagree on "Best Hospitals"

According to the USA Today, nearly 40% of consumers surveyed last year said they use hospital ratings to choose a health care facility, but there's little agreement among the lists, raising questions about their value. Consumers pore over reviews and ratings of everything from cars to washing machines, but it's doctor and hospital rankings that may be the most confusing and controversial. At least 15 different groups, ranging from news publications such as U.S. News & World Report to the federal government through its "Compare" websites, rank health care organizations, but no two judge them the same way, which leads to widely divergent results.

A survey of consumers' views on hospitals conducted last year by the Robert Wood Johnson Foundation and Harvard School of Public Health, found Americans evenly split on whether they think there are big or small differences in the quality of care among their local hospitals. And while 38% said they rely on rankings to choose a hospital, 57% said they'd more likely go to a hospital they were familiar with than they would go to one because it had a high ranking.

Some rankings focus more in a particular area, such as patient safety, and other ranking organizations think that is too narrow a focus and try to capture a broader set of information. One thing that all sides seem to agree on is that there is a larger benefit to society if hospitals work to improve their rankings on the myriad lists.

Newsweek Blog Post: Are Hospitals Less Safe Than We Think?

This blog post by Johns Hopkins surgeon, Marty Makary, M.D., describes the well-know problem of the risks of over-utilization of health care services, argues that no other industry tolerates such a high "failure" rate, and states that a new generation of doctors has been developing fair and simple ways to measure how well patients do at individual hospitals. In hospital-speak, we call the information “sensitive data”—data that would tell you which hospitals have much worse outcomes than others. Dr. Makary advocates for as much transparency as possible in the health care system and cautions against the potential devastating effects of a lack of accountability at the individual provider level.

As he states, "Politicians debate different ways to pay for our broken system. But if we are going to get serious about reducing health-care costs—and improving health-care outcomes—we need to address the 20 percent of medical care that is unnecessary and dangerous. The public should demand disclosure of a hospital’s patient-outcome statistics. After all, we have information on a car’s safety record to inform our decision about which car to buy. But when it comes to choosing medical care, the consumer is left to walk in blind. While we currently have a free market for health care, the competition is at the wrong level. Many patients tell me they choose their medical care based on parking. For an industry that represents one sixth of the U.S. economy, we can do better than that."

Coalitions and employers have a vital advocacy role to play when it comes to data transparency and holding the health care system accountable for outcomes.

AHRQ Seeks to Tap Patients for Safety-Event Data

The Agency for Healthcare Research and Quality is seeking approval to design and test a system for collecting information from patients about healthcare safety events, according to a Federal Register filing (PDF).

Based on a growing body of evidence that many medical adverse events go unreported by providers, AHRQ is seeking to create a way for patients and their families to report healthcare safety events. “Most reporting systems do not presently accept or elicit reports from patients and their families,” AHRQ wrote, and “the unique perspective of healthcare consumers could reveal important information that is not reported by healthcare providers.”

AHRQ already has funded the development of a prototype Consumer Reporting System for Patient Safety, and the agency's current request to the Office of Management and Budget would test the prototype's effectiveness.

The project is being conducted by AHRQ through a contractor, Rand Corp., with Brigham and Women's Hospital, Dana Farber Cancer Institute, both in Boston, and ECRI Institute, Plymouth Meeting, PA.

National Quality Forum Endorses Four New Sets of Measures

On Friday, August 10, the National Quality Forum (NQF) endorsed new measures in four new domains of care: cancer, patient safety, care coordination, and disparities.

The 22 cancer care measures are focused on conditions such as leukemia, prostate cancer, and multiple myeloma, but also on issues that affect care delivery – including radiation dose limits, hospice readmissions, and care planning.

Two new patient safety measures that are focused on complications were endorsed. The measures address venous thromboembolism prophylaxis and current medication documentation in medical records.

The 12 measures of care coordination touch on such critical areas of concern as reconciling patients’ medications, establishing advance care plans, and the timely availability of medical records (to other caregivers and patients themselves) when patients are discharged from hospitals and other in-patient facilities.

The 12 disparities measures are focused on healthcare disparities and culturally competent care for racial and ethnic minority populations.

NBCH is in the process of developing member education and strategy related to measures. If you have feedback on how NBCH can meet your coalition's needs in this area, please contact Colleen Bruce.

How safe is your hospital?

Approximately 400 people die every day because of hospital errors – the equivalent of a jet crashing every day and killing all aboard. In response to this silent epidemic, more than 2,600 U.S. hospitals will now receive an A, B, C, D or F Hospital Safety Score based on patient safety via a first-of-its-kind initiative.

A Blue Ribbon Panel of the nation’s top patient safety experts provided guidance to The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits, to develop the Hospital Safety Score. The Hospital Safety Score is calculated using publicly available data on patient injuries, medical and medication errors, and infections.

NBCH member coalitions make up the majority of the Regional Roll-Out Leaders for Leapfrog.

Coalitions will use the Hospital Safety Score in their communities to work with employers and other purchaser members on contracting, value-based purchasing, benefits design, and employee educational programs to spur safety improvements in our hospitals.

NTOCC Launches Transitions of Care Evaluation Tool for Health Care Quality Improvement

The National Transitions of Care Coalition (NTOCC), an organization dedicated to improving patient transitions through the healthcare system, has launched a new tool to facilitate the advancement of care quality. The Transitions of Care Evaluation Software, a web-based program provided at no cost to the user, is designed to meet the needs of organizations ready for an advanced stage of transitions of care improvement efforts.

Available through a secure Internet website accessible from NTOCC's homepage, the software is a convenient, online option for institutions looking to document and evaluate transitions initiatives. User features include data entry, data analysis and report generation, allowing for data visualization over time. In addition, multiple evaluation projects may be managed under a single organization's umbrella.

The Transitions of Care Evaluation Software is available at http://www.ntocc.org/, where interested parties may learn more and preview the platform, register for an account and begin using the Software.

U.S. Physician Groups Identify Commonly Used Tests or Procedures They Say are Often Not Necessary

Nine physician organizations have each identified five tests or procedures that may be overused or unnecessary as part of the Choosing Wisely campaign led by the ABIM Foundation, with Consumer Reports in an effort to improve health care quality and patient safety.

Patient advocates are calling the move a significant step toward improving the quality and safety of health care.

The lists of “Five Things Physicians and Patients Should Question” include:

Leapfrog Group releases 2011 results to reduce early elective deliveries

This week The Leapfrog Group announced the 2011 results from the annual Leapfrog Hospital Survey indicating that hospitals are making progress in eliminating early elective newborn deliveries, with 39% of reporting hospitals keeping their early elective delivery rate to 5% or less, compared to 30% of reporting hospitals last year.

Additional information can be found here.

New initiative from Partnership for Patients aimed at improving hospital care

HHS announced a new program focused on providing hospitals across the country will new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from health care acquired conditions.

An initiative of the Partnership for Patients, a nationwide public-private collaboration to improve the quality, safety, and affordability of health care for all Americans, $218 million will go to 26 state, regional, national, or hospital system organizations. As Hospital Engagement Networks, these organizations will help identify solutions already working to reduce healthcare acquired conditions, and work to spread them to other hospitals and health care providers.

The 26 organizations receiving awards are:

End this medical secrecy

Transparency in health care is one of the key tools consumers have to help them judge the quality of health care. Transparency allows the public to see where mistakes have been made. Unfortunately, that transparency has been steadily disappearing under the misnamed "Patient Safety and Quality Improvement Act," which not only allows data about medical mistakes to be hidden, it makes disclosing quality problems at providers a crime for anyone except the providers involved. Read the full article...

New Maryland health program promotes care for the whole patient

The state launched a program that offers financial incentives for comprehensive patient care. Doctors are encouraged to come up with coordinated care among health-care providers to place a focus on preventing illness, rather than waiting until it needs costly treatment. Read the full article...

Quality Matters "Hospital at Home" Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers

Hospital at home programs that enable patients to receive acute care at home have proven effective in reducing complications while cutting the cost of care by 30 percent or more, leading to entrepreneurial efforts to promote their use. But widespread adoption of the model in the U.S. has been hampered by physicians’ concerns about patient safety, as well as legal risk, and by the reluctance of payers, including Medicare, to reimburse providers for delivering services in home settings. Read the full post...

NQF: Patient Safety–Complications Endorsement Maintenance

The Patient Safety–Complications Endorsement Maintenance Call for Measures is now open. This project seeks to identify and endorse measures that specifically address complications-related patient safety issues. In addition, 47 NQF-endorsed® consensus standards will undergo maintenance review. The Call for Measures is open through Wednesday, September 14, at 6:00 pm ET. Submit your measures now.