Payers & Providers California Edition – Issue of April 14, 2011

8/7/2019 Payers & Providers California Edition Issue of April 14, 2011

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More than 10% of Californias acute carehospitals reported incidents involving aforeign object being left in a patient,according to a 20-month data sampling

compiled by the Centers for Medicare andMedicaid Services.

Altogether, 45 hospitals reported to CMS54 incidents where a patient retained a foreignobject between October 2008 and June 2010 a rate of nearly three per month. Thosehospitals that reported foreign objects had anaverage rate of occurrence more than 120times higher than the nationwide average,according to the CMS data.

The CMS released the data whichfocused on what it calls hospital-acquiredincidents last week over considerableresistance from the hospital industry. Its

release came just days before the U.S.Department of Health and Human Serviceslaunched an initiative to reduce hospital-acquired injuries (See In Brief, p. 2)

Any potentially preventablecomplication of care is unacceptable, saidCMS Administrator Donald Berwick, M.D.We at CMS are working together with thehospital and consumer community to bringhospital acquired conditions into the forefrontand do all we can to eliminate harm from thevery healthcare system intended to heal us.

Along with the retention of foreignobjects, the agency also released nationwide

data on incidences of central-line blood

infections, catheter-acquired urinary tractinfections, injuries sustained by preventablefalls, burns and electrical shocks, and fourother categories where the care being

provided resulted in an injury inicted on apatient during their hospitalization. As part ofan initiative enacted in 2008, CMS will nolonger reimburse Medicare or Medicaidclaims to hospitals for performing correctiveactions on an affected patient.

A foreign object retained by a patient typically during surgery is considered one ofthe most serious of hospital-acquiredconditions, an error safety experts agreevirtually always places patients in immediatejeopardy of harm due to the risk of infectionand the need to undergo a second procedureto remove the object. Such reported events

also often lead to surveys by the CaliforniaDepartment of Public Health, which mayissue administrative penalties and insist thefacilities take corrective actions.

According to information posted on theCDPH website, none of the incidentsdisclosed by CMS last week have led to suchactions by that agency. However, CDPH doesnot publicly release data on ongoinginvestigations, and often announcesadministrative penalties of hospitals months oreven years after an investigation is conducted.

A CDPH spokesman did not

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Ma 4-7

May 11-13

Calendar

14 April 2011

April 20

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[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

www.lakesidecommunityhealthcare.com

California Edition

CMS Spotlights In-Hospital Incidents45 Facilities Statewide Report Retained Objects

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Payers & Providers Page 2

Top Placement...Bottomless Potential

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In Brief

HHS Launches InitiativeTo Focus On

Preventable Injuries

The U.S. Department of Healthand Human Services has launchedan initiative aimed at cutting downon preventable injuries andcomplications related tohealthcare delivery.

The Partnership for Patients isintended to reduce hospital-acquired conditions by 40%, saveupward of 60,000 lives over thenext three years, and $35 billion inhealthcare costs, including $10billion for the Medicare program.

Americans go the hospital toget well, but millions of patientsare injured because of preventablecomplications and accidents, said

HHS Secretary Kathleen Sebelius.Working closely with hospitals,doctors, nurses, patients, familiesand employers, we will supportefforts to help keep patients safe,improve care, and reduce costs.Working together, we can helpeliminate preventable harm topatients.

HHS will pledge $1 billion forthe effort, which was earmarked bythe Patient Protection andAffordable Care Act. About 500hospitals, physician and nursingorganizations have pledged theirsupport for the initiative.

Grubb & Ellis AcquiresLoma Linda Pediatric

Hospital

The Santa Ana-based Grubb & EllisHealthcare Real Estate InvestmentTrust has purchased the LomaLinda Pediatric Specialty Hospital.

Continued on Page 3

NEWS

CMS Data (Continued from Page One)

immediately respond to telephone and e-mailrequests for comment.

Industry observers expressed concern

regarding the data.Even one incident is not good, as thereare very strong and proven protocols toprevent this from happening, said Jim Lott,executive vice president of the HospitalAssociation of Southern California. Lottadded that his organization may make suchincidents the focus of future educationalcollaboratives and seminars.

I know what the trends are, and wedont see it improving, said John Keats, M.D.,chairman of the steering committee for theCalifornia Patient Action Safety Coalition, avolunteer consortium of about 60 hospitals

and medical groups throughout the state. Itsa matter of how institutions are reacting, andare they doing appropriate (examinations of)root causes, and are they making adjustmentsto these cases. It is hard work.

Debby Rogers, vice president of qualityfor the California Hospital Association, notedthat some of the incidents could haveinvolved leaving tiny pins or screws in cardiacor orthopedic patients events that arereported but the result of an overt decision bya clinician rather than an inadvertentomission. Although Keats conrmed suchincidents occur, neither could say if those

predominated in the cases reported to CMS.Of those hospitals that reported retained

objects, seven reported more than oneincident. Tri-City Medical Center inOceanside reported three such incidents, asdid Los Robles Medical Center in ThousandOaks.

Tri-City spokesperson Kelli Moors saidthat two of the cases involved patients whoappeared at the hospital with objects in theirbodies that had been introduced at the ofcesof their personal physicians. Were required

to report those cases, she said. Moors couldnot provide details on the third incident.

Tri-City has received two administrative

penalties from CDPH, one in 2010 for burninthe face of a patient during a surgicalprocedure and another in 2009 for apreventable fall that led to a patient breakingtheir hip. That patient died during surgery torepair the hip.

Los Robles has never received anadministrative penalty. A Los Roblesspokesperson was unable to conrm if theincidents are under investigation by CDPH.

In addition to Tri-City and Los Robles,Cedars-Sinai Medical Center in Los Angeles,Methodist Hospital of Sacramento,Providence Saint Joseph Medical Center in

Burbank, UCSF Medical Center and UC DaviMedical Center all reported two incidents ofretained surgical objects.

UC Davis spokesperson Carole Gan saidits cases involved unexpected failures of asurgical device that left small parts in twopatients. Because it was not in the bestinterest of the (patients) at the time to continuefforts to retrieve it, a second surgery wasscheduled, Gan said.

Fresno Surgical Hospital, a 31-bed facilitthat focuses primarily on elective procedures,also reported 13 incidents involving patientswho were injured by falls or other form of

trauma a rate about 17 times higher than thenationwide average.

Chief Executive Ofcer Kristine Kassahnsaid she had noticed the high rate of patientfalls when she took the position in September2008.

We have put many processes in placethat include identication of high-risk patientpatient education and hourly rounding by

CEO/COO/CFO COMPENSATIONPAYERS & PROVIDERS EXCLUSIVE WHITE PAPERCOMPENSATION ON MORE THAN 300 OF CALIFORNIAs

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Page 3Payers & Providers

Longer ALOS!*

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*For our ads, not your hospital

NEWS

In Brief

HEALTHCARES BEST ADVERTISING VALU]PAYERS & PROVIDERS reaches 5,000 hospital, health plan and noprot executives statewide. There is no better venue for marketi

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CMS Data (Continued from Page One)

The 71-be facility includes asubacute pediatric unit and anintermediate care facility fordevelopmentally disabledchildren. The hospital has beenoperated by Mountain View ChildCare, Inc.

The (hospital is) affiliatedwith top-tier health systems andlocated in proximity to a thrivingmedical center, and is afinancially healthy asset that issupportive of our investordistribution, said Grubb & EllisHealthcare REIT President DannyProsky.

Heritage ProviderNetwork Offers $3MPredictive Modeling

Prize

Marina del Rey-based HeritageProvider Network is offering a $3million prize to any organizationthat is able to prevail in apredictive modeling simulation.

Contestants in the challengewill be provided with a data setconsisting of the de-identifiedmedical records of patientscovering a specific time period,and will then be required topredict who from that patientpopulation went to the hospitalduring the following year, as wellas their length of hospitalization.

"We have an opportunity to

globally change health deliveryand ensure a higher quality ofcare, while making healthcareaffordable for families andavoiding waste," said HeritageCEO Richard Merkin, M.D.

The competition will last twoyears to ensure contestants wouldbe able to create the mostaccurate predictive modelingalgorithm, Merkin said. Details onthe competition are available atwww.heritagehealthprize.com.

nursing personnel, Kassahn said in an e-mail response. She added that the fall rateamong Fresno Surgicals patients decreased60% by last year.

UC Davis, UCLA Medical Center andLoma Linda University Medical Center alsoreported relatively high incidents of hospital-acquired infections revolving around central-line blood infections. The condition isconsidered avoidable if precautions aretaken when the central line is inserted.

Together, the three hospitals reported59 separate central line infections, with theirratio of occurrence about ve to six timeshigher than the nationwide average.

UC Davis also reported another 26cases of catheter-related urinary tractinfections, about eight times higher than thenationwide average.

Gan said the hospitals reportedinfections may include some suspectedcases of infection that were not conrmed bylaboratory results. She added that thehospital has had an aggressive program inplace with the goal of reducing infections tozero.

Rogers observed that the elevatedinfection may also be due to the facilitieshaving a higher than average patient load, aswell as the fact they are all level one trauma

centers for their service areas.Patients with major trauma are athigher risk for infection, and academicmedical centers also treat many patients withfar more co-morbidities than otherhospitals, Rogers said.

CMS spokesperson Jack Cheeversconrmed Rogers assertions to some degree,stating that while teaching hospitalsrepresent 8% of all hospitals nationwide,they are responsible for 20% of all patient

discharges and 25% of all surgical discharges.Keats also observed that teaching

hospitals are combating new organisms thatcan lead to patients being infected moreeasily.

Were seeing some strange organisms outthere, and the larger and more complicatedthe facility, the more likely its a contributingfactor, he said.

Marshall Medical Center in Placervillealso had a high rate of urinary tract infections its 13 cases were nine times higher than thenational average. Donna Hayman, thehospitals director of quality management, saidthe facility had undertaken several initiatives,including more hand washing for hospital staff

and the use of antibiotic-eluting catheters.Hayman added that Marshalls numbershad improved during the months of the CMSreporting, but that it was hidden in the overallaggregation of data. We made improvementsin 2009 and 2010, but you cant see it in thenumbers, she said.

Rogers noted that since this was the rsttime CMS had released data of this type, itwould be signicant to compare the data withfuture releases.

How are the trends going to look inanother year? Rogers said. Its going to beimportant to see if theyre trending in the right

direction.Keats maintained there was signicantroom for improvement. You will never get tothe point where these events are eliminatedentirely, he said. But people can agree thatthere are better ways to follow policies andprocedures to reduce their rate of occurrence.

Payers & Providers has posted the CMSdata for California. To view it, click on this linkhere.
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Payers & Providers PageOPINION

The Essential Role of Case ManagerThey Can Make or Break Hospitals Bottom Lines

Kathleen Miodonski is a manager with The

Camden Group.

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FD$GE!/4!%12H!1>!C-!$#!+1%+B*/%)*+I@!^-++!]-20%)*56!(&)*+(40>*-./0)*+@B-: Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

[email protected],

Hospitals across the country are lookingincreasingly to their case managementdepartments to provide support in this rapidlychanging environment. Addressing risinghealthcare costs is a key component of health-care reform and has spawned a variety of newpayment methodologies. Managed-care plansare tightening reimbursements and MedicareRecovery Audit Contractor audits are exertingeven more pressure on hospitals nancialhealth.

Hospital case managers have been valuedfor their understanding of health-caredelivery and ability to combine

quality, efciency, and resourcemanagement in delivery of patientcare. The need for an effective andresponsive case managementdepartment has never been greater.

Here are ve indications a casemanagement department needsimprovement :

1. Senior leadership isunableto identify the impact or describethe value of case management intheir organization. Seniorleadership may not understandwhat case management staff does, but the

impact of case management activities shouldbe evident and regularly reported. Casemanagement impact on accounts receivable,length-of-stay and throughput data, denial ratesfor medical necessity, as well as appeals,overturned denials, and use of observationstatus are some of the metrics that candemonstrate the value case management bringsto an organization. Leaders of effective casemanagement departments use tools such as abalanced scorecard to highlight the outcomesof effective rocesses and programs.

2. Physicians, particularly hospitalists, havenegative or neutral attitudes and opinions of

the value of case management. Physicianpractice patterns drive resource consumptionin patient care. Successful case managementdepartments understand this fundamental factand have employed strategies to partnereffectively with physicians. Collaborativepartnerships with physicians promote cost-effective care through support of decision-making, promoting care progression, and carecoordination. Case managers add value tophysician practice.

3. Key operational areas do not have acollaborative relationship with casemanagement. Case management departmeninteract with virtually every department in thhospital. It is imperative, however, that the cmanagement department has productive andcollaborative relationships with the nursing,nance, and contracting departments. Thenursing department should recognize andsupport case management as a professionalspecialty. Effective care coordination re-quircase managers to work closely with the beds

nurses. Utilization review and denmanagement activities, coupled w

open communication with thenance and contracting areas, canprovide useful in-formation about effect of health plan contracts on oerations and the revenue cycle.

4. The hospitals reputation witthe payer community is not favora

for utilization management. Worganized and executedutilization management activitin hospitals translate to smoothoperations for health plansanan uninterrupted revenue cycle

hospitals. Case management departments tha

submit timely and accurate utilization reviewdecrease denials from health plans.

5. Representatives ofpost-acute venuesexpress frustration with discharge planningactivities. Discharging patients to post-acutecare is a complex process requiring skilledassessment; thorough communication with thhealthcare team, patients and payers; andcoordination of many ancillary services. Casmanagement departments that can shepherdpatients through this process smoothly willenjoy positive relationships with post-acutevenues and patients. alike. Consistentlydemonstrating well-executed discharge plans

increases the likelihood that post-acute venuwill partner with hospitals in accepting patiewith more complex discharge planning needwith positive impact on length-of-stay.

By Kathleen

Miodonski


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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

WERE GROWING!

The Integrated Healthcare Association (IHA) is a statewide multi-stakeholder leadership groupthat promotes quality improvement, accountability and affordability of health care in California.IHA is a nonprot association!working to actively convene all healthcare parties for cross sectorcollaboration on health care topics. IHA administers regional and statewide programs and servesas an incubator for pilot programs and projects.!

PROGRAM MANAGER!Manages the CA pay for performance (P4P) program related to quality measurement; leads andsupports program committees comprised of executive representatives of organizationsparticipating in the program; oversees the data collection, aggregation, analysis, handling of

appeals, and distribution of results to physician groups and health plans for quality and efciencymeasures; builds positive relationships with stakeholders and maintains ongoing communicationsvia various methods to keep them informed. Required: 5-10 years experience in health caredelivery or managed care; BA/BS required; Masters Degree preferred in health-related eld.!

ANALYST / SENIOR ANALYST!Supports the Bundled Episode Payment demonstration with project coordination and developsclinical, data, or quality supporting materials for the project. The demonstration is in a dynamicstart-up phase; project assignments might include participant report formats and specications,communications recruiting support and dissemination of information about our preliminary

ndings and results.!Required:! Excellent analytic and critical reasoning skills; effectiveinterpersonal and communication skills; BA/BS required in health-related eld; Masters Degree orclinical training preferred.!!Join our dynamic team working on exciting statewide programs and projects!!!For complete jobdescriptions, visit: www.iha.org.! To apply, email Cindy Ernst at [email protected].


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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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Payers & Providers California Edition – Issue of April 14, 2011

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