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December 22, 2014 Download print version

Medicare cuts payments to 721 hospitals with highest rates of infections, injuries

Ebola deaths pass 7,000

Saint Louis natives set out to reduce HAIs

Duplication error may make giants

Map: How prepared are states for infectious disease outbreaks?

Emerging U.S. health threats to be explored at MEDICAL WORLD AMERICAS 2015

The odd math of medical tests: One scan, two prices, both high

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Medicare cuts 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 Women’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 “hospital-acquired conditions,” 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 “there’s a pretty strong sense among the experts we talked to that they are not widely implemented,” 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 “a big deal, but it’s only a start.” 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 — 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 — with a total score above 7 — 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 “critical access hospitals” 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 hospital’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 organ transplants.

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 aureus, (MRSA).

Visit here for the HAC Penalty Chart (PDF).

Visit Kaiser for the full release.

 

Ebola deaths pass 7,000

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 country’s southeast forest region, where he said the number of infected people “seems to continue to grow”.

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 “are there to help you”.

This past week, officials in Conakry, the capital in Guinea, announced a ban on New Year’s Eve celebrations such as fireworks displays and beach gatherings in a bid to curtail transmission. (Associated Press) Visit Nation News for the report.

 

Saint Louis 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 HAIs.

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.

“Our program is an active training environment with monthly updates and inclusion of new regulations and topics on a regular basis,” said Wellington. “Healthcare 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 ICU’s success. 

“ICU is available to hospitals at no cost and features a state-of-the-art Learning Management System,” said Sears, Co-founder and VP of Strategic Relationships at ICU.  “Along 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 Prevention (CDC).”

Visit www.infectioncontroluniversity.com.

 

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 Medicine.

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 “Outbreaks: Protecting Americans from Infectious Disease,” a new report assessing readiness for infectious threats and conducted by the Trust for America’s Health and the Robert Wood Johnson Foundation.

“It 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,” the report’s authors write of their scoring system, based on 10 indicators of preparedness. The states that scored highest—8 points each—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 “offer a composite snapshot of strengths and vulnerabilities across the health system,” 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 labs.

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 nation’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 don’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 year’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.

 

Emerging U.S. health threats to be explored at MEDICAL WORLD AMERICAS 2015

Even though TIME magazine named “the Ebola fighters” 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, “This was a test of the world’s ability to respond to potential pandemics, and it did not go well.”

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 – 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 Action

·         Beyond the Headlines: Critical Questions Facing Health Care Executives Today

Session 2 – Game Changers in Healthcare

·         Smart Technology

·         No Longer Science Fiction - Emerging Infectious and Tropical Diseases and the New Realities and Risks of World-Wide Pandemics

Session 3 – Data Driven Healthcare

·         Leveraging Big Data to Drive Research Discoveries

·         Transforming Big Data into Clinical Practice

“MWA 2015 is convening experts who are on the front line of transforming how we practice medicine,” said Robert Robbins, M.D., President and Chief Executive Officer of Texas Medical Center and Chairman of the MWA Executive Committee. “From 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 for patients.”

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 www.MedicalWorldAmericas.com.

 

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 — 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 — 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.

“Old technology should be like old TVs: The price should go down,” said Dr. Naoki Ikegami, a health systems expert at Keio University School of Medicine in Tokyo, who is also affiliated with the University of Pennsylvania’s business school. “One 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.”

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 said.

American doctors, clinics and hospitals tend to order lots of tests. “It’s one of the most lucrative revenue streams they have,” said Dr. Eric J. Topol, a cardiologist at Scripps Health in San Diego who studies echocardiography. “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.”

Health considerations are not the only factor driving the use of echocardiograms in America. In Britain’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. Thomas’ 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 “it’s a black hole what’s going on in offices,” 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 millions annually.

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 — $330 million out of $1.1 billion — 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 Japan’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 costs.

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 doctor’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 United States.

Visit the New York Times for the article.