payments to 721 hospitals with highest rates of infections, injuries
In its toughest crackdown yet on medical errors, the federal government is
cutting payments to 721 hospitals for having high rates of infections and
other patient injuries, records released Thursday show.
Medicare assessed these new penalties against some of the most renowned
hospitals in the nation, including the Cleveland Clinic, Brigham and Womenâ€™s
Hospital in Boston, the Hospital of the University of Pennsylvania in
Philadelphia and Geisinger Medical Center in Danville, PA.
One out of every seven hospitals in the nation will have their Medicare
payments lowered by 1 percent over the fiscal year that began Oct. 1 and
continues through September 2015. The health law mandates the reductions for
the quarter of hospitals that Medicare assessed as having the highest rates
of â€śhospital-acquired conditions,â€ť or HACs. These conditions include
infections from catheters, blood clots, bed sores and other complications
that are considered avoidable.
The penalties, which are estimated to total $373 million, are falling
particularly hard on academic medical centers: Roughly half of them will be
punished, according to a Kaiser Health News analysis.
Dr. Eric Schneider, a Boston health researcher who has interviewed patient
safety experts for his studies, said research has demonstrated that medical
errors can be reduced through a number of techniques. But â€śthereâ€™s a pretty
strong sense among the experts we talked to that they are not widely
implemented,â€ť he said. Those methods include entering physician orders into
computers rather than scrawling them on paper, better hand hygiene and
checklists on procedures to follow during surgeries.
The penalties come as the hospital industry is showing some success in
reducing avoidable errors. A recent federal report found the frequency of
mistakes dropped by 17 percent between 2010 and 2013, an improvement U.S.
Health and Human Services Secretary Sylvia Burwell called â€śa big deal, but
itâ€™s only a start.â€ť Even with the reduction, one in eight hospital
admissions in 2013 included a patient injury, according to the report from
the federal Agency for Healthcare Research and Quality, or AHRQ.
The new penalties are harsher than any prior government effort to reduce
patient harm. Since 2008, Medicare has refused to pay hospitals for the cost
of treating patients who suffer avoidable complications. Legally, Medicare
can expel a hospital with high rates of errors from its program, but that
punishment is almost never done, as it is a financial death sentence for
most hospitals. Some states issue their own penalties â€” California, for
instance, levies fines as high as $100,000 per incident on hospitals that
are repeat offenders.
Hospitals complain that the new penalties are arbitrary, since there may be
almost no difference between hospitals that are penalized and those that
narrowly escape falling into the worst quarter. Hospital officials also
point out those that do the best job identifying infections in patients may
end up looking worse than others.
The penalties come on top of other financial incentives Medicare has been
placing on hospitals. This year, Medicare has already fined 2,610 hospitals
for having too many patients return within a month of discharge. This is the
third year those readmission penalties have been assessed. This is also the
third year Medicare gave bonuses and penalties based on a variety of quality
measures, including death rates and patient appraisals of their care. With
the HAC penalties now in place, the worst-performing hospitals this year
risk losing more than 5 percent of their regular Medicare reimbursements.
In determining the HAC penalties, Medicare judged hospitals on three
measures: the frequency of central-line bloodstream infections caused by
tubes used to pump fluids or medicine into veins, infections from tubes
placed in bladders to remove urine, and rates of eight kinds of serious
complications that occurred in hospitals, including collapsed lungs,
surgical cuts, tears and reopened wounds and broken hips. Medicare tallied
that and gave each hospital a score on a 10-point scale. Those in the top
quarter â€” with a total score above 7 â€” were penalized.
About 1,400 hospitals are exempt from penalties because they provide
specialized treatments such as psychiatry and rehabilitation or because they
cater to a particular type of patient such as children and veterans. Small
â€ścritical access hospitalsâ€ť that are mostly located in rural areas are also
exempt, as are hospitals in Maryland, which have a special payment
arrangement with the federal government.
In evaluating hospitals for the HAC penalties, the government adjusted
infection rates by the type of hospital. When judging complications, it took
into account the differing levels of sickness of each hospitalâ€™s patients,
their ages and other factors that might make the patients more fragile.
Still, academic medical centers have been complaining those adjustments are
insufficient given the especially complicated cases they handle, such as
Medicare penalized 143 of 292 major teaching hospitals, the KHN analysis
found. Penalized teaching hospitals included Ronald Reagan UCLA Medical
Center and Keck Medicine of USC in Los Angeles; Grady Memorial Hospital in
Atlanta; Northwestern Memorial Hospital and University of Illinois Hospital
in Chicago; George Washington University Hospital and Washington Hospital
Center in Washington, DC.
The penalties are reassessed each year and Medicare plans to add in more
kinds of injuries. Starting next October, Medicare will assess rates of
surgical site infections to its analysis. The following year, Medicare will
examine the frequency of two antibiotic-resistant germs: Clostridium
difficile, (C. diff), and methicillin-resistant Staphylococcus
Visit here for the
HAC Penalty Chart (PDF).
Visit Kaiser for the full release.
Ebola deaths pass
The worst Ebola outbreak on record has now killed more than 7,000 people,
with many of the latest deaths reported in Sierra Leone, the World Health
Organization (WHO) said as United Nations (UN) Secretary-General Ban Ki-moon
continued his tour of Ebola-affected countries in West Africa.
The three countries hit hardest by Ebola have now recorded 7,373 deaths, up
from 6,900 on Wednesday, according to WHO figures posted online late Friday.
A total of 392 of the new deaths were in Sierra Leone, where Ebola is
spreading the fastest.
The new totals include confirmed, probable and suspected Ebola deaths. The
WHO says there have also been six Ebola deaths in Mali, eight in Nigeria and
one in the United States. The total number of cases in Guinea, Sierra Leone
and Liberia now stands at 19,031, up from 18,569.
Ban arrived in Guinea, meeting with President Alpha Conde, expressing
concern about the situation in the countryâ€™s southeast forest region, where
he said the number of infected people â€śseems to continue to growâ€ť.
The region borders Liberia, Sierra Leone and Ivory Coast, and Ban called for
cross-border collaboration to bring the disease under control. He urged all
Guineans to commit themselves to eradicating Ebola, saying that the U.N. and
its partners â€śare there to help youâ€ť.
This past week, officials in Conakry, the capital in Guinea, announced a ban
on New Yearâ€™s Eve celebrations such as fireworks displays and beach
gatherings in a bid to curtail transmission. (Associated Press)
Visit Nation News for the report.
natives set out to reduce HAIs
After 25 years of talking to hospital administrators and infection control
officials, Thom Wellington felt that the knowledge of reducing Hospital
Acquired Infections (HAIs) could be more easily delivered with an online
training portal. Wellington and his partner, Tom Sears, created Infection
Control University (ICU) to be a provider of managing risks and reducing
ICU recently launched a new online learning center that provides Infection
Control Awareness training certification to all hospital and vendor
employees who work in healthcare facilities. ICU is a cloud-based learning
center that provides staff and vendors with 24/7 access to information and
proven techniques to help reduce HAIs, all at no cost to the hospital.
â€śOur program is an active training environment with monthly updates and
inclusion of new regulations and topics on a regular basis,â€ť said
Wellington. â€śHealthcare employees and vendors can connect to our cloud-based
application 24/7 via desktop computer or through any smart device.
To help launch ICU, Wellington turned to Tom Sears, Co-Founder of Research
Based Solutions. Sears is a learning and behavioral management expert who
helped launch the internationally recognized research organization in 2011.
The company creates and sells behavior-based assessments and sophisticated
learning management systems that are used around the world to improve
productivity, reduce turnover, and prepare individuals for success. With
this background, Sears established a plan for ICUâ€™s success.
â€śICU is available to hospitals at no cost and features a state-of-the-art
Learning Management System,â€ť said Sears, Co-founder and VP of Strategic
Relationships at ICU. â€śAlong with an Infection Control Awareness training
certification, the patent-pending training program meets American Institute
of Architects (AIA) protocols, saves valuable time, enforces safer work
practices and helps to promote a much safer, healthier facility. These
elements meet the requirements of the Center for Disease Control and
Duplication error may make giants
A duplication in a short stretch of the X chromosome may be responsible for
a specific type of gigantism seen in children, researchers reported. These
patients with early-onset gigantism had a microduplication on chromosome
Xq26.3 in which four genes were duplicated, one of them being GPR101 which
probably drives the condition. Constantine Stratakis, MD, DSc, of the
National Institutes of Child Health and Human Development, and
colleagues reported the condition online in the New England Journal of
They called it a "striking phenotype of gigantism that has an onset in early
childhood and that is caused by an excess of growth hormone," and proposed
that the syndrome be called X-linked acrogigantism (X-LAG).
The research began when a mother who had been treated for gigantism brought
her two sons who were also growing rapidly to the NIH for treatment in the
1990s, followed by a second Australian patient with gigantism who came to
the institute. All of these patients had the duplication on chromosome
Xq26.3, according to NIH.
Stratakis then collaborated with Albert Beckers, MD, PhD, of the University
of Liege in Belgium, who had been following patients with gigantism and
acromegaly for most of his career. The two groups pooled their research
efforts in order to study 43 patients with gigantism, 13 of whom had
microduplication on chromosome Xq26.3.
They noted that, among those with gigantism who didn't carry the
duplication, none had disease onset before age 5.
In this duplicated stretch of DNA, the researchers found four genes. One of
them, GPR101, encodes an orphan G-protein coupled receptor and is probably
the sequence that creates the phenotype in young children, they reported.
Stratakis said a next step is to understand exactly how the protein derived
from GPR101 works, with the ultimate goal of developing new treatments for
children with gigantism.
Visit MedPage Today for the study.
Map: How prepared
are states for infectious disease outbreaks?
Arkansas is the state least prepared for an infectious disease outbreak,
according to a new analysis. But no state is perfect: none scored higher
than an eight on the 10-point scale used in â€śOutbreaks: Protecting Americans
from Infectious Disease,â€ť a new report assessing readiness for infectious
threats and conducted by the Trust for Americaâ€™s Health and the Robert Wood
â€śIt is not a comprehensive review; but collectively, it provides a snapshot
of efforts to prevent and control infectious diseases in states and within
the healthcare system,â€ť the reportâ€™s authors write of their scoring system,
based on 10 indicators of preparedness. The states that scored highestâ€”8
points eachâ€”were Maryland, Massachusetts, Tennessee, Vermont and Virginia.
Half the states scored a six, seven or eight. Arkansas alone scored two.
D.C. earned a score of five.
The scores were determined by how states ranked along 10 indicators chosen
by consulting with leading public health officials. Together, they â€śoffer a
composite snapshot of strengths and vulnerabilities across the health
system,â€ť the authors write.
The indicators evaluated such things as public health funding, information
management, childhood and flu vaccination rates, preparedness for the public
health impacts of climate change and food safety.
The indicator on which states were most successful measured the capabilities
of public health laboratories during emergencies or drills. Between July
2013 and July 2014, 47 states and DC conducted an exercise or used a real
event to test how long it took for urgent information to travel between
The indicator on which the fewest states succeeded measured efforts to
minimize healthcare-associated infections, in which patients contract an
infection while receiving medical treatment. The study evaluated two such
types, but the one on which states scored worst evaluated those in which
infections were spread by the insertion of a central line to provide medical
treatment. Only 10 states saw such infections fall from 2011 to 2012.
Thirty-five states and DC have already met a federally set child vaccination
goal as part of the Healthy People 2020 initiative to improve the nationâ€™s
health by that year. The goal is to ensure that at least 90
percent of children aged 19 months to 35 months get at least three doses of
the Hepatitis B vaccine.
The CDC estimates that anywhere from 700,000 to 1.4 million people are
infected with Hepatitus B and nearly two in three of them donâ€™t know it. It
is typically transferred from mother to child during birth and the vaccine
has been available since 1982.
Just 14 states vaccinated at least half their population aged six months or
older for the seasonal flu during last yearâ€™s flu season, according to the
study. South Dakota had the highest vaccination rate, of 57.4 percent.
The majority of states scored well on food safety, with 38 meeting national
goals of testing reported cases of the common food-borne illness E. coli
(Escherichia coli O157, to be precise). The national goal is to test 90
percent of reported cases within four days. Sixteen states achieved that
goal 100 percent of the time.
Visit the Washington Post for the report.
health threats to be explored at MEDICAL WORLD AMERICAS 2015
Even though TIME magazine named â€śthe Ebola fightersâ€ť as the 2014 Person of
the Year, the Ebola outbreak proved the healthcare community has work to do.
At the MEDICAL WORLD AMERICAS (MWA) 2015 conference and expo, industry
leaders will collaboratively discuss this and other pressing healthcare
challenges, lessons learned and breakthrough innovations they can implement
immediately. As TIME says in the announcement, â€śThis was a test of the
worldâ€™s ability to respond to potential pandemics, and it did not go well.â€ť
Now it is more important than ever for healthcare professionals to work
together to protect the health of our communities and country. Leading
experts will convene at MWA from April 27-29 at the George R. Brown
Convention Center in Houston to explore innovations in healthcare through
three plenary sessions:
Session 1 â€“ Collaborating to Address Health Problems
The First Annual TMC Health Policy Institute Health Care Survey: What
Patients Really Want in Their Health Care System
Clinton Health Matters Initiative: Houston and Harris County Blueprint for
Beyond the Headlines: Critical Questions Facing Health Care Executives Today
Session 2 â€“ Game Changers in Healthcare
No Longer Science Fiction - Emerging Infectious and Tropical Diseases and
the New Realities and Risks of World-Wide Pandemics
Session 3 â€“ Data Driven Healthcare
Leveraging Big Data to Drive Research Discoveries
Transforming Big Data into Clinical Practice
â€śMWA 2015 is convening experts who are on the front line of transforming how
we practice medicine,â€ť said Robert Robbins, M.D., President and Chief
Executive Officer of Texas Medical Center and Chairman of the MWA Executive
Committee. â€śFrom the man who led the response to the Ebola outbreak in
Texas, to the doctor who performed the first surgery using Google Glass,
this forum will share practical and exciting breakthroughs in how we care
Conference participants will be the first to learn about the results of a
landmark survey that explores what patients are seeking in their healthcare
experience in 2015 and beyond. Tim Garson, M.D., M.P.H., of Texas Medical
Center, will provide insights into the broader implications of these
findings and how healthcare practitioners can address them.
As part of MWA, participants will also experience a comprehensive view of
the future of the industry through an expansive showcase which includes
hundreds of state-of-the-art medical devices, technologies, products and
services. In addition, at least nine physician and nursing sessions will
offer continuing education credits for attendees.
MWA launched last year as a unique collaboration between the Greater Houston
Convention and Visitors Bureau (GHCVB), Germany-based Messe Dusseldorf, the
Texas Medical Center and Houston First Corp. The inaugural session brought
together a diverse group of over 2,000 medical professionals from 33
countries, including the U.S.
More information is available at
The odd math of
medical tests: One scan, two prices, both high
From a medical perspective, blood work, tests and scans are tools to help
physicians diagnose and monitor disease. But from a business perspective,
they are opportunities to bring in revenue â€” especially because the
equipment to perform them has generally become far cheaper, smaller and more
highly mechanized in the past two decades.
And echocardiograms, ultrasound pictures of the heart, are enticing because
they are painless and have no side effects â€” unlike CT scans, blood draws,
colonoscopies or magnetic resonance imaging tests, where concerns about
issues like radiation and discomfort may be limiting. Though the machines
that perform them were revolutionary and expensive when they first came into
practice in the 1970s, the costs have dropped considerably. Now, there are
even pocketsize devices that sell for as little as $5,000 and suffice for
some types of examinations.
â€śOld technology should be like old TVs: The price should go down,â€ť said Dr.
Naoki Ikegami, a health systems expert at Keio University School of Medicine
in Tokyo, who is also affiliated with the University of Pennsylvaniaâ€™s
business school. â€śOne of the things about the U.S. health care system is
that it defies the laws of economics, and of gravity. Once the price is
high, it just stays there.â€ť
With pricing uncoupled from the actual cost of business, large disparities
have evolved. The seven teaching hospitals in Boston, affiliated with
Harvard, Tufts and Boston University, charge an average of about $1,300 for
an echocardiogram. There are even wide variations within cities: In
Philadelphia, prices range from $700 to $12,000.
Dr. David Wiener, the chairman of the advocacy committee of the American
Society of Echocardiography, acknowledged the wide price disparities but
said he did not believe they were greater than those for other healthcare
services and procedures. He attributed the variations to multiple factors,
including how many hospitals and doctors perform the procedure, state
regulations and the need to subsidize poorly reimbursed services.
In other countries, regulators set what are deemed fair charges, which
include built-in profit. In Belgium, the allowable charge for an
echocardiogram is $80, and in Germany, it is $115. In Japan, the price
ranges from $50 for an older version to $88 for the newest, Dr. Ikegami
American doctors, clinics and hospitals tend to order lots of tests. â€śItâ€™s
one of the most lucrative revenue streams they have,â€ť said Dr. Eric J. Topol,
a cardiologist at Scripps Health in San Diego who studies echocardiography.
â€śAt many hospitals, the threshold for ordering an echocardiogram is the
presence of a heart.â€ť
Health considerations are not the only factor driving the use of
echocardiograms in America. In Britainâ€™s National Health Service, all
echocardiograms are done in hospitals without charge. There are about 250
echocardiogram centers in the country, said Dr. John Chambers, a
cardiologist at St. Thomasâ€™ Hospital in London who studies echocardiography.
By contrast, in the United States, buying an echocardiogram machine is a
good investment for an entrepreneurial practice. The number of
echocardiograms ordered by cardiologists in the United States rose 90
percent from 1999 to 2008, according to a 2012 study. There are far more
places to get one in New Jersey than in all of Britain, according to the
Intersocietal Accreditation Commission, which accredits medical facilities.
High-end echocardiogram machines are generally rolled around on wheels and
cost under $300,000, about one-third of the price three decades ago when
adjusted for inflation. Laptop-size systems cost $30,000 to $100,000, and
are suitable for all but the most complicated cases.
While academic hospitals have led the call for more targeted use of
echocardiograms, not all doctors comply, and â€śitâ€™s a black hole whatâ€™s going
on in offices,â€ť said Dr. Rory B. Weiner, a professor at Harvard Medical
School. There is not even a good estimate of how many of the procedures are
performed in the United States, although it is clearly in the tens of
The profit margin on the test is impossible to calculate because purchase
prices for the machines are secret. GE declined to provide price information
for its machines in the United States or other countries. Nor would it
reveal how many machines it sold in the United States, other than to say
that one-third of its global sales â€” $330 million out of $1.1 billion â€” were
in this country.
Claims data shows that Japanese patients received 6.6 million
echocardiograms last year, about five times the rate per capita in Britain.
Despite Japanâ€™s fondness for testing, its health spending is about $4,000 a
year a person, or 9.6 percent of gross domestic product. By contrast, the
United States spends more than $9,000 per person annually, more than 17
percent of G.D.P., although some studies indicate that healthcare spending
is leveling off.
Hospitals and doctors in the United States also spend far more on
administrative costs than those in any other country. Even for a relatively
simple test like an echocardiogram, commercial insurers often demand
preapproval, and a host of middlemen and staffers are involved, driving up
Although medical groups cite malpractice lawsuits for the high prices in the
United States, some studies suggest that is not a major factor. What did
predict price in a region, according to the analysis? The more machines, the
higher the bills.
The newest miniature echocardiogram machines fit into a doctorâ€™s white-coat
pocket and, placed on the chest during an office exam, provide a snapshot of
the heart. No longer do physicians have to listen for subtle clicks and
whooshes through a stethoscope. Even primary care doctors in training can
use the devices, which sell for well under $10,000, to detect basic heart
problems with a few hours of instruction, according to studies.
Such machines are being widely used in other countries and in pilot programs
at some medical schools, but they are receiving a lukewarm welcome in the
Visit the New York Times for the article.