Release of 2010 Indiana Medical Errors Report Poorly Covered by Media

Although dated for 11/7/2011, the 2010 Indiana Medical Error Report was released to the public on 11/28/2011.

The link to the press release is here.
The link to the report itself is here.
The link to the data tables (containing facility specific numbers) is here.

In the month since the release of this report, coverage from the media has been disappointing. A brief google scan of Indiana news coverage shows the following:

• The Indy Star and WTHR carried the same small piece on 11/29/2011 highlighting that bed sores were the most commonly reported error and foreign objects left inside patients after surgery was the second. To it's credit, the report did not single out any hospital with high raw numbers.
• However, on the day that the report was released, WTHR posted a separate story on its website highlighting that medical errors had reached a new high. Unfortunately, it reported raw numbers of events at various central Indiana facilities without any type of responsible interpretation. This story did attempt to offer readers advice on how to stay safe, however, the reporter clearly confused prevention concepts (surgery site marking, patient turning) with error reporting ("...what can you do if you suspect an error?).
• On 12/2/2011, the Palladium-Item from Richmond, IN, carried a story highlighting the performance of its local hospital (Reid). It focused on the two patients that Reid reported fell in 2010 causing serious disability or death. It appears that the reporter (Pam Tharp) did interview hospital officials (a vice president, the director of patient safety and quality, and a spokesman) and provided quotes to balance the reported numbers. The story then proceeded to report the 5-Year reporting high, but noted possible explanations (changes in operational definitions) for this.
• The Herald-Bulletin (Anderson), ran a story on 12/8/2011 describing the performance of the two area hospitals. The CEO of Community hospital provided detail of the hospitals process to minimize missing sponges and that it seeks to learn from its errors. The President of Saint John's Hospital and its CNO both provided similar detail as to how it prevents bed sores. Healthcare quality professionals will be happy to see that this article also noted that "Medical errors generally are not the sole result of people’s actions but rather the failure of the systems and processes used in providing health care... The requirement to report events identifies persistent problems, encourages increased awareness of patient safety issues and assists in the development of evidence-based initiatives to improve patient safety."

Of the above referenced coverage, it would appear that the reporter from the Herald-Bulletin (Abbey Dole) provided the most responsible reporting of the annual Medical Error report. With a story that could easily be irresponsibly covered to incite and inflame the public, this reporter educated the public on how the medical error reporting system helps healthcare in Indiana become safer.

Schneck Medical Center (Seymour, IN) Named 2011 Baldrige Award Recipient

Schneck Medical Center of Seymour, Indiana, was named a 2011 Baldrige Award Recipient in the Healthcare Category. Schneck is the first organization from Indiana to receive the Baldrige Award.

Until recently, Indiana did not have a State level Baldrige-based award program. Schneck thus partnered with the Ohio Partnership for Excellence. The Ohio program has since expanded its scope and now covers the State of Indiana (as well as West Virginia). The program has now been renamed The Partnership for Excellence.

The press release announcing the other Baldrige Award winners can be found here.

The profile of Schneck Medical Center released with the announcement can be found here.

Below are excerpts from the profile of Schneck Medical Center outlining its quality performance that may be interesting to the healthcare quality professional. Note that the 50 page Baldrige application from Schneck will become public domain in a few months and thus awailable for public examination and learning. Schneck (as required by all Baldrige award winners) will also be participating in national and regional conferences where they will be sharing thier Baldrige journey.

• SMC consistently demonstrates high levels of performance in relation to patient-focused health care measures. Specifically, on 17 of 22 core measures reported for the Centers for Medicare and Medicaid Services (CMS), SMC scored 100 percent in the second quarter of 2011.
• SMC ranked second among 94 hospitals in its geographic region and outperformed all local competitors when measured for its value-based purchasing (VBP). VBP is a method that holds health care providers accountable for the quality and cost of their services through a system of rewards and consequences. Incentives discourage inappropriate, unnecessary, and costly care.
• Patient satisfaction surveys reflect SMC’s year-to-year favorable performance, meeting or exceeding top 10 percent or top 25 percent levels on nine of 10 Press Ganey (a national consulting firm focused on improving health care performance) measures, including inpatient quality of care, inpatient family support, inpatient coordination of care, and inpatient customer service. On measures of ambulatory care, including timeliness, customer service, and ambulatory education, SMC’s performance exceeds the top 25 percent level.
• SMC’s commitment to a “Patient First” culture has led to many innovative health care options. For example, to address its limited treatment options for myocardial infarctions, SMC and its largest competitor, located 25 miles away, created a collaborative initiative for coordinated handoffs of patients needing emergency cardiac catheterizations. Through this effort, “door-to-balloon” times (the critical period for assessing and diagnosing a heart attack and delivering the needed intervention) have been reduced from 120 to as low as 60 minutes, ensuring patients get the best and quickest treatment.
• SMC has achieved high performance levels in all areas measured by the Hospital Consumer Assessment of Healthcare Providers and Systems, with SMC outperforming its Indiana peers from 2008 to 2011 (year-to-date) in the areas related to the ability of nurses and physicians to listen, understand, and provide clear discharge instructions.
• SMC demonstrates role-model performance through its low overall rates of hospital-acquired infections, which have been maintained at or below 1 percent since 2008. There have been no occurrences of postoperative infections from bariatric surgeries, one of SMC’s focus areas. No patient has acquired ventilator-associated pneumonia since 2009, while central line-associated bloodstream infections have remained at low numbers since 2008, with zero cases in 2011 (year-to-date).
• SMC demonstrates excellence in measures of its operating margin, cash flow, and cash position, with its reported results comparing favorably to the Standard & Poor’s (S&P) “A-” and “AA” rated median levels. From 2008 to 2010, SMC’s gross revenue results showed growth in the organization’s strategic focus areas—women’s health, joint replacement, noninvasive cardiac care, cancer care, and bariatric surgery.

CMS to inspect 1/3 of all Ambulatory Surgery Centers this Year Regarding Infection Prevention Practices

In a press release from HHS Secretary Kathleen Sebelius on June 8, a clear signal was sent to ambulatory surgery centers that they will be receiving additional attention from CMS regarding their infection prevention and control practices.

The press release is cut and pasted here. Sections of interest to the healthcare quality professional are highlighted in red.


FOR IMMEDIATE RELEASE
Tuesday, June 8, 2010
Contact: HHS Press Office
(202) 690-6343


HHS Secretary Kathleen Sebelius Statement on Recent Study of Infection Control Practices in Ambulatory Surgical Centers

“Today, the Journal of the American Medical Association published a new study from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), which underscored the urgency behind the Obama Administration’s efforts to reduce healthcare-associated infections (HAIs).

The study found that among a sample of ambulatory surgical centers (ASCs) in three states, two-thirds had infection control lapses identified during routine inspections. This is concerning, because when lapses in infection control occur, in any healthcare setting, it puts patients at risk.

The good news is that we have seen progress in the reduction of HAIs in the hospital setting. Just last month, a new report from CDC demonstrated progress made in reducing HAIs in hospitals, further indicating that the steps we’re taking to reduce these often preventable infections are working. The report showed an 18-percent decrease in national central-line associated bloodstream infection incidence in hospitalized patients.

Ensuring the safety of all patients in all healthcare settings is a top priority for HHS. That’s why I announced last year that $50 million of American Recovery and Reinvestment Act funds to help states fight HAIs. Of that funding, $10 million went to states to improve the process and increase the frequency of inspections for ambulatory surgical centers.

In addition, the Affordable Care Act calls for improvements in healthcare quality and HAIs. Research shows that when healthcare facilities identify where and when infections are likely to occur and take concrete steps to prevent them, some infection rates have dropped more than 70 percent in hospitals.

We also continue to strengthen our collaborative efforts to achieve the goals in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ophs/initiatives/hai/). In 2010, HHS will expand its Action Plan to include strategies to eliminate HAIs in ambulatory surgical centers and hemodialysis centers.

HHS’ Agency for Healthcare Research and Quality (AHRQ) is contributing to the reduction of infections in ASCs by investing in research projects to better understand the factors that lead to HAIs in ambulatory surgical settings. HHS agencies are also working together to incorporate infection control into the inspection process. CMS has committed to inspecting one-third of all ASCs nationwide this year. All ASCs have a responsibility to correct deficient practices. Failing to correct serious deficiencies will mean the risk of termination from the Medicare program.

Just because procedures are being performed outside the hospital doesn’t mean patient safety standards and attention to infection control do not need to be met. All healthcare providers and suppliers should take this as an opportunity to evaluate their current infection control policies, and more importantly, make sure their staff understand and follow them.”

To view the infection control audit tool currently used by CMS to better assess infection control practices in ambulatory surgical centers, please visit: http://www.cms.gov/manuals/downloads/som107_exhibit_351.pdf

Joint Commission Updates Sentinel Event Statistics

The Joint Commission reported today that it has updated its sentinel event statistics through December 31, 2009.

The updated statistics can be found here: http://www.jointcommission.org/NR/rdonlyres/377FF7E7-F565-4D61-9FD2-593CA688135B/0/SE_Stats_31_Dec_2009.pdf

The sentinel events data webpage is here: http://www.jointcommission.org/SentinelEvents/Statistics/

Wrong site surgery is still the leading sentinel event.

Commonwealth Fund Highlights Accomplishments of Reid Hospital

Last week the Commonwealth Fund highlighted the SCIP achievements of Reid Hospital (Richmond, IN) by publishing a case study on both the Commonwealth Fund's website
as well as their http://www.whynotthebest.org/ website.

The case study can be download here: http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Nov/1338_Edwards_Reid_Hospital_case_study.pdf

The following is the summary section of the case study with sections of interest in red.

Reid Hospital and Health Care Services is a high performer on process-of-care, or “core” measures. The measures, developed by the Hospital Quality Alliance (HQA), relate to achievement of recommended care in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. This case study focuses on Reid’s achievement in providing recommended care to surgical patients in order to reduce the risk of a hospital-acquired infection.

Quality of care has been high on Reid’s agenda since the late 1990s, when the hospital began using a report card to track health care processes and outcomes. In 2004, the multidisciplinary Surgical Care Improvement Project Quality Action Team was formed, which hospital leaders’ credit with helping to achieve high performance on the surgical measures. The team is supported by:

• a strong board, administrators, and clinical leaders;
• a clinical information system that aligns physicians’ orders with hospital standards, and alerts nurses about the timing of critical care;
• physician and nurse champions;
• performance data analysis and feedback; and
• a "just do it" approach to quality improvement.
  

CMS Releases Hospital Outpatient and Ambulatory Surgery Center Payment Update

Last week CMS released the CY2010 hospital outpatient payment update in a final rule with comment period. Hospitals will be getting a 2.1% increase in payments from Medicare, however, hospitals that are not participating in HOP QDRP will only be getting 0.1% increase.

The full text of the press release is below with items of interest to hospital quality professionals in Red.

The full text (1936 pages!) of the final rules (with comment period) can be downloaded at: http://federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf
The HOP QDRP section starts on page 1135.

(Note! CY2012 HOP QDRP Measures under consideration can be found on page 1167.)



FINAL 2010 POLICY, PAYMENT CHANGES FOR HOSPITAL OUTPATIENT DEPARTMENTS AND AMBULATORY SURGICAL CENTERS‏

OVERVIEW

On Oct. 30, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that updates payment policies and rates for both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year (CY) 2010. The update to ASC rates constitutes the third year of a four-year transition to a revised payment system that aligns ASC payment rates with those paid to HOPDs for similar services. The final rule with comment period also seeks to promote higher quality, efficient services for Medicare beneficiaries by adopting improvements to the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) and establishing procedures to make the data collected through the HOP QDRP publicly available.

CMS projects that total payments for services furnished to people with Medicare in HOPDs during CY 2010 under the Outpatient Prospective Payment System (OPPS) will be $32.2 billion, while total projected CY 2010 payments under the ASC payment system will be approximately $3.4 billion.

OUTPATIENT PROSPECTIVE PAYMENT SYSTEM

Background:

Since August 2000, Medicare has paid hospitals for most services furnished in their outpatient departments under the OPPS. Medicare currently pays more than 4,000 hospitals ‑‑ including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities,
long-term acute care hospitals, children’s hospitals, and cancer hospitals ‑‑ for outpatient services under the OPPS. Medicare also pays community mental health centers (CMHCs) under the OPPS for partial hospitalization services. The OPPS payments cover facility resources including equipment, supplies, and hospital staff, but do not pay for the services of physicians and nonphysician practitioners who are paid separately under the Medicare Physician Fee Schedule (MPFS).

All services under the OPPS are classified into groups called Ambulatory Payment Classifications (APCs). Services in each APC are similar clinically and require the use of similar resources. A payment rate is established for each APC. The APC payment rates are adjusted for geographic cost differences, and payment rates and policies are updated annually through rulemaking. The final rule is generally issued by November 1 each year and, unless otherwise specified, becomes effective January 1 of the subsequent year.

Beneficiaries share in the cost of services under the OPPS by paying either a 20 percent coinsurance rate or, for certain services, a copayment required under the Medicare law not to exceed 40 percent of the total payment for the APC. The statutory copayment is gradually being replaced by the 20 percent coinsurance as the composition of APC groups is updated in response to policy changes or new cost data. CMS estimates that the overall beneficiary share of the total payments for Medicare covered outpatient services will be about 22.6 percent in CY 2010.

Significant Changes For Calendar Year 2010

CMS projects that the aggregate Medicare payments to providers under the OPPS in CY 2010 will be $32.2 billion, a $1.9 billion increase over projected payments in CY 2009.

Implementing New Coverage Authorized by MIPPA: The final rule with comment period implements several expansions of Medicare coverage that were required in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), including:

Kidney disease education –CMS is establishing payment to rural providers under the Medicare Physician Fee Schedule (MPFS) for kidney disease education services furnished on or after Jan. 1, 2010 for Medicare beneficiaries diagnosed with Stage IV chronic kidney disease.

Pulmonary and cardiac rehabilitation – CMS is establishing OPPS payment for new, comprehensive pulmonary and intensive cardiac rehabilitation services furnished to beneficiaries with chronic obstructive pulmonary disease, cardiovascular disease, and related conditions, effective Jan. 1, 2010.


Strengthening Ties between Payment and Quality:
Payment reduction for failure to report quality measures – As required by law, CMS will reduce the CY 2010 annual inflation update factor by two percentage points for most services furnished by hospitals that failed to meet the CY 2009 reporting requirements of the HOP QDRP. The reduction will not apply to payments for separately payable pass-through drugs, biologicals and devices, separately payable non-pass-through drugs and non-implantable biologicals, separately payable therapeutic radiopharmaceuticals, and services assigned to New Technology APCs.

Quality measures to be reported – CMS will continue to require hospitals subject to HOP QDRP requirements to provide quality data for the current 7 chart-abstracted emergency department and surgical care measures and 4 claims-based imaging efficiency measures for CY 2011 payment determinations.

Validation of quality reporting – CMS will be implementing a HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures using chart-abstracted data. Under this requirement, CMS will select a sample of reported cases, request the corresponding medical records, re-abstract the HOP QDRP chart-abstracted measures, and compare the results with the measures reported by the hospital. Hospitals will be required to return paper copies of requested medical records for this CY 2011 requirement within a 45 calendar day timeframe. However, the validation results will not affect a hospital’s CY 2011 OPPS payment. This initial validation requirement for CY 2011 will provide hospitals an opportunity to become familiar with the process for future years.

Public reporting of quality data – CMS is establishing procedures to make HOP QDRP quality measure data publicly available as early as June 2010.

Supervision of Hospital Outpatient Services:
· Supervision requirements for outpatient services – In order to ensure that hospital outpatient services are appropriately supervised by qualified practitioners while not impeding beneficiary access to these services, and in response to concerns raised by the hospital community, CMS is revising or further defining several current policies for the supervision of outpatient services. First, in CY 2010, CMS will allow certain nonphysician practitioners ‑ specifically physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers ‑ to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.


For purposes of on-campus hospital outpatient therapeutic services, CMS is defining “direct supervision” to mean that the physician or nonphysician practitioner must be present anywhere on the hospital campus and immediately available to furnish assistance and direction throughout the performance of the procedure. For services furnished in an off-campus provider-based department, “direct supervision” would continue to mean that the physician or nonphysician practitioner must be present in the off-campus provider-based department and immediately available to furnish assistance and direction throughout the performance of the procedure.

CMS also will require that all hospital outpatient diagnostic services furnished directly or under arrangement, whether provided in the hospital, in a provider-based department, or at a nonhospital location, follow the MPFS physician supervision requirements for individual tests.

Payment for Drugs, Biologicals, and Radiopharmaceuticals:
Drugs and pharmacy overhead – CMS will pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status at the average sales price (ASP) plus 4 percent in CY 2010. The payment rate of ASP plus 4 percent is based upon the cost of separately payable drugs and biologicals calculated from hospital claims and cost reports (ASP minus 3 percent), with an adjustment for pharmacy overhead cost that reflects the redistribution of $200 million of the pharmacy overhead cost currently attributed to packaged drugs and biologicals (both coded and uncoded) to separately payable drugs and biologicals without pass-through status.

Pass-through implantable biologicals – Beginning in CY 2010, implantable biologicals that are surgically implanted (through a surgical incision or a natural orifice) and that are not receiving pass-through payment before Jan. 1, 2010 will be evaluated for pass-through status using the device category pass-through process rather than the drug and biological pass-through process. Implantable biologicals that initially qualify for device pass-through status beginning on or after Jan. 1, 2010 will be paid at hospitals’ charges adjusted to cost for the two to three year pass-through payment period.

Drug and biological pass-through payment eligibility period – Consistent with current policy, in CY 2010, CMS will continue to recognize the first date of OPPS pass-through payment of ASP plus 6 percent as the beginning of the two to three year pass-through payment eligibility period for a new drug or non-implantable biological.

· Therapeutic radiopharmaceuticals – Beginning Jan. 1, 2010, CMS will provide payment for separately payable therapeutic radiopharmaceuticals with ASP data at ASP plus 4 percent. If ASP data are not available, payment will be based upon mean unit cost from hospital claims data. Subregulatory guidance on submitting ASP for OPPS radiopharmaceutical payment based on ASP is available on the CMS Web site at: www.cms.hhs.gov/HospitalOutpatientPPS/.

Payment for Brachytherapy Sources:
CMS is adopting the proposal to pay for brachytherapy sources based on median unit costs in CY 2010, as calculated from claims data according to the standard OPPS ratesetting methodology.

Partial Hospitalization Services, including Services Provided by CMHCs:
CMS will continue paying two separate partial hospitalization program (PHP) per diem rates: one for days with three services ($150) and one for days with four or more services ($211). The CMHC multiple outlier threshold will continue to be set at 3.4 times the APC payment amount for the higher intensity partial hospitalization day for CY 2010.


AMBULATORY SURGICAL CENTERS

Background:

There are approximately 5,000 Medicare-participating ASCs. Since Jan. 1, 2008, ASCs have been paid under a revised ASC payment system that both aligns payment in ASCs and hospital outpatient settings by basing ASC payment rates on the APC relative weights for similar services and extends payment to more surgical services in ASCs than under the prior payment system. To minimize the impact of the revised payment system, the ASC payment rates calculated under the new ratesetting methodology are being phased in over four years. CY 2010 is the third year of the transition. In general, the revised ASC payment rate for a surgical procedure is a percentage of the payment rate for the same procedure under the OPPS; however, there are a few exceptions. For device-intensive procedures (assigned to a subset of the OPPS device-dependent APCs where device costs account for more than 50 percent of the total cost of the service), ASCs receive the same payment for the device cost as under the OPPS. For new ASC procedures that are predominantly performed in physicians’ offices, the ASC payment is capped at the amount the physician is paid under the MPFS for practice expenses for providing the same procedure in an office.

In the CY 2008 final rule that revised the ASC payment system, CMS added approximately 800 procedures to the list of ASC procedures for which payment could be made. Only those surgical procedures that would be expected to pose a significant safety risk to beneficiaries or that would be expected to require an overnight stay following the procedure are excluded from the ASC list. These changes in payment policies for ASCs give patients broader access to surgical services in settings that are clinically appropriate.

Significant Changes For Calendar Year 2010:

ASC Payment Rate Updates: The revised ASC payment rates were established to reflect the same relativity of resource use among procedures as under the OPPS, taking into consideration the lower costs of surgical procedures performed in ASCs and maintaining budget neutrality in the payment system. By law, CY 2010 is the first year that CMS may provide an inflation update under the revised ASC payment system. The percentage increase in the Consumer Price Index for All Urban Consumers that updates the ASC conversion factor for CY 2010 is 1.2 percent.

Changes to ASC Covered Surgical Procedures and Covered Ancillary Services: CMS is adding 26 surgical procedures to the list of procedures for which Medicare would pay when performed in an ASC. CMS also is newly designating 6 procedures as office-based procedures (subject to payment at the lesser of the national office practice expense payment to the physician or the national ASC rate), and temporarily designating an additional 16 procedures as office-based procedures based on coding changes for CY 2010. The final rule with comment period also updates the list of device-intensive procedures and covered ancillary services and their rates, consistent with the OPPS update.

The CY 2010 OPPS/ASC final rule with comment period will appear in the Nov. 20 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern time on Dec. 29, 2009. CMS will respond to comments in the CY 2011 OPPS/ASC final rule.
For more information on the CY 2010 final rule with comment period for the OPPS and ASC payment system, please see the CMS Web site at:
OPPS: http://www.cms.hhs.gov/HospitalOutpatientPPS/
ASC payment system: http://www.cms.hhs.gov/ASCPayment/

AHRQ Tools and Resources to Prevent HAIs.

In early September, the AHRQ released a webpage highlighting research and resources related to the prevention of hospital acquired infections. This is an excellent site that links to tools and resources for both healthcare providers as well as healthcare consumers.

You can find the website here.

2008 Indiana Medical Errors Report Released

On 8-20-09 the Indiana State Dept. of Health released its 2008 report on medical errors reported by hospitals, ambulatory surgery centers, and abortion clinics via the reporting system mandated by the Governor in 2005 to start CY2006.

The State's Medical Error Reporting System webpage is here: http://www.in.gov/isdh/23433.htm (Note: The State frequently changes its webpage urls and thus the link may become useless at any time. It was working this morning.)

The 2008 report itself can be found here: http://www.in.gov/isdh/files/2008_MERS_Report.pdf
Data Tables: http://www.in.gov/isdh/files/2008_MERS_Data_Tables.pdf
Appendix: http://www.in.gov/isdh/files/2008_MERS_Appendices.pdf

The 2008 Report also contains descriptions of patient safety improvements efforts and activities that are ongoing throughout the state.

Note that the reporting rules have changed for CY2009. Prior to 1-1-09, 27 events had to be reported. Twenty-Eight events are now covered by the reporting system. The new list is here: http://www.in.gov/isdh/files/28_REPORTABLE_EVENTS.pdf

The release of the report has been lightly covered by local media:
IndyStar: http://www.indystar.com/apps/pbcs.dll/article?AID=2009908210343
WTHR: http://www.wthr.com/Global/story.asp?s=10964770

IHA Update

The following is the most recent legislative update from the IHA. Items that may be of interest to healthcare quality professionals are in red.

General Assembly Faces April 29 Deadline
With the final day for action in the General Assembly less than one week away, conference committees are busy working out compromises between House and Senate versions of legislation. There are plenty of meetings today and rumors that more will be scheduled for Saturday and even possibly Sunday. Needless to say, many members of the General Assembly will not be headed home for the weekend.

Many significant bills failed to clear both chambers, but legislation that previously passed either the House or Senate is usually eligible to be placed into another “live” bill. Check the latest Bill Track to see which bills are headed to conference committee, which ones could be brought back, and which ones likely remain off the table in 2009.

In addition to monitoring the final days of the legislative session, IHA will also participate in the American Hospital Association’s annual meeting in Washington, D.C. and engaging with members of Congress. Key topics that will be addressed are the needs of hospitals in the current economic and financial crisis, concerns over the Employee Free Choice Act, possible reductions in Medicare reimbursement, and national health reform.

HIP Changes in Limbo (SB 472)
IHA has closely followed SB 472, authored by Sen. Pat Miller (R-Indianapolis), even after the hospital assessment and the “HIP 2” proposal was removed earlier this session. As it passed the Senate, this legislation would have allowed certain Hoosiers to buy into the HIP program without state support by paying the full premium as well as making any POWER account contributions. It also would have specified that the minimum POWER account contribution required for HIP enrollees would be $60 (FSSA believes that this minimum payment is critical to maintaining the element of personal responsibility within the HIP program).

In addition to the eligibility changes, SB 472 would have also permitted non-for-profit foundations to contribute to a participant’s required POWER account payments. As passed in the Senate, the amount a not-for-profit could contribute would be 50 percent. Later amendment in the House increased the share to 75 percent.

Other amendments added in the House would have broadened HIP eligibility by reducing the time for which an individual must be without health insurance from six to three months. Another change would increase the share that participating employers can pay for employees’ POWER account payments from 50 percent to 75 percent.

The bill was withdrawn before a third reading vote in the House, and it did not pass before the deadline on April 16. Some raised concerns that certain elements of SB 472 could lead to Hoosiers dropping their private insurance to join HIP. It is important to note that while the cap of 34,000 has been reached for non-parental adults, sufficient funding remains available to enroll thousands more eligible parents or “caretaker adults” in HIP.

The language allowing foundations to contribute to POWER accounts was of particular interest to many hospitals, and it could be revived in a different bill before session’s end. Such language, however, has not yet been inserted into any other conference committee reports.

Indiana Innovation Alliance May Be Funded
There has been only one public conference committee meeting to date on HB 1001, but the prospects for Indiana Innovation Alliance funding improved when it was included in the Senate-passed budget. This proposal is a joint request by Indiana and Purdue Universities, and hospitals may be particularly interested in the component of the program to expand medical education to include two- to four-year programs in Bloomington, Evansville, Fort Wayne, Gary, Indianapolis, Muncie, New Albany, South Bend, Terre Haute, and West Lafayette.

The Senate Republicans’ budget assumed the latest revenue forecast would reflect a shortfall of $1 billion, but by fully-utilizing the significant dollars allocated to Indiana through the stimulus legislation they were able to accommodate this program in their plan.

The Senate provided approximately $26 million for state fiscal years 2010 and 2011 as follows:

• $5 million/year: Medical Education Center Expansion (to increase the medical school class size by 30 percent statewide)
  
• $3.8 million/year: Technical Assistance and Advanced Manufacturing (to expand post-graduate pharmacy residency training for post-graduate biomedical engineering specialization and for the Healthcare TAP program at Purdue)
  
• $11.3 million/year: Core Research
  
• $5.6 million/year: Matching Grants for Federal Research Projects

IU and Purdue were seeking a total of $35 million per year, and the House budget funded the whole program at this level in its one-year budget bill earlier in the session. You can read more about the Alliance at http://www.indianainnovationalliance.org/.

Smokefree Air Legislation Revived
As indicated in the most recent IHA Bill Track, a good deal of legislation that was previously approved by only one chamber remains in play—very little is ever entirely dead during conference committees. HB 1213, the smoke-free air bill, passed the Indiana House by a vote of 70-26, but did not receive a hearing in the Senate Commerce and Public Policy & Interstate Cooperation Committee. However, the author of the original bill, Rep. Charlie Brown, has attempted to insert a revised proposal into HB 1208.

In a conference committee meeting this week, the contents of HB 1208 (establishing a mental health corrections quality advisory committee and a related multi-agency task force) were moved into another bill and replaced with a smoke-free air proposal. The conference committee has not yet acted on HB 1208, but Rep. Brown has asked other legislators to assess what level of support exists for his proposal. To move HB 1208 forward for a full vote in the House and Senate, all four conferees would have to sign off on the report. Rep. Eric Turner, Sen. Connie Lawson, and Sen. Vi Simpson are the other conferees along with Rep. Brown.

The bill as originally introduced contained a comprehensive smoking ban in public places, including bars, casinos, and all other enclosed areas of employment. The bill was lauded by IHA and the Indiana Campaign for Smokefree Air (of which IHA is a member) as a major step forward in protecting the health of Hoosier workers. The bill met a set-back when the House Public Policy Committee passed a heavily amended bill that exempted casinos and most bars.
Rep. Brown has proposed to exempt only casinos in HB 1208. However, since the chair of the Senate Commerce Committee did not hear the original bill, we do not expect that the conferee representing the Senate majority caucus (Sen. Lawson) would sign any conference committee report on this topic.

Admitting Privileges Receive Scrutiny
As it passed the Indiana Senate earlier this session, SB 89 would have required physicians performing abortions in Indiana to have “admitting privileges” at a hospital in that county or an adjacent county. When the bill came to the House Public Policy Committee, IHA was asked to testify on SB 89 solely to provide answers regarding the nature of admitting privileges.

SB 89 was later expanded greatly on the House floor on April 13 and passed the House on April 15. The changes to the bill include requiring any “health care provider licensed by the state” performing a “surgical procedure” to have admitting privileges at a hospital in that county or an adjacent county. “Surgical procedure” was not further defined, which meant that thousands of medical professionals could be impacted.

Although this problematic language passed, other proposals that would have mandated how hospitals award admitting privileges were defeated. It is likely that admitting privileges will continue to receive scrutiny from now until the end of the session on April 29. On Tuesday, the Indianapolis Star published an article on SB 89 and cited information provided by IHA. Read the article here: http://www.indystar.com/article/20090421/NEWS05/904210376.

Sen. Patricia Miller has dissented with the changes made by the House and the matter will likely be taken up by a conference committee. The Senate has appointed conferees and advisers but the House had not yet named its appointments as of April 23. IHA anticipates that the language broadening the requirement to all surgical procedures will be removed. IHA will continue to monitor the bill and defend against any possible attempts to dictate how hospitals grant admitting privileges.

State Revenue Forecast Mixed; Documents Online
The new state forecast projects that Indiana will take in slightly more tax revenue over the biennium than some had feared, but this optimism has been openly questioned by legislators. The budget writers will have about $830 million less than was estimated based on the December 2008 forecast, but some expected the shortfall to exceed $1 billion.

Following the presentation to the State Budget Committee, the forecast documents were posted to the Budget Agency’s website. The “Economic Outlook” document from Nigel Gault, chief U.S. economist for HIS Global Insight, is particularly interesting: http://www.in.gov/sba/2489.htm.

NQF Releases Safe Practices for Better Healthcare 2009 Update: A Consensus Report

A few days ago, the NQF released its 2009 Update of a previously released consensus report: Safe Practices for Better Healthcare.


The following is an excerpt of the document description posted on the NQF website:

Safe Practices for Better Healthcare—2009 Update presents 34 practices that have been demonstrated to be effective in reducing the occurrence of adverse healthcare events. This revised set of NQF-endorsed safe practices has been updated with current evidence and expanded implementation approaches, and it provides additional measures for assessing the implementation of the practices.

As of today, only the electronic pdf version of the report is available. You can buy it here for $29.99.
A free summary report is here.


Did you miss out on the 2006 version? ...Not sure if your hospital can pay you back the $30? You can download the 2006 version for free at: http://www.qualityforum.org/pdf/projects/safe-practices/SafePractices2006UpdateFINAL.pdf

Interestingly, a quick Internet search will reveal the draft version of the 2009 version here.

Feb 11 IHA Newsletter

The most recent IHA newsletter was released on Feb 11. The following is a cut and paste of items relevant to the Healthcare Quality Professional. The full newsletter can be found here.

IHA Board Takes Action on Issues
At its Feb. 6 meeting, the IHA Board of Directors passed a resolution encouraging hospitals to test the WHO Surgical Safety Checklist. A study published in the New England Journal of Medicine demonstrates that use of the checklist during major operations can reduce the incidence of deaths and complications by more than one-third.

More Indiana Hospitals Test Surgical Checklist
More IHA members have reported testing the WHO Surgical Safety Checklist. IHA and IHI are challenging hospitals to test the checklist in one operating room, by one surgical team, one time before April 1. Click here to view the list of IHA members who have already participated. Contact Mikell Brown at 317/423-7726 or mbrown@ihaconnect.org when your hospital has tested the checklist to have your hospital added to the IHA list.

IHA Monitors Stimulus Bill; Compile Project Lists
Congress is still hammering out a compromise between the House and Senate on the stimulus legislation. IHA is uncertain of what will be in the final version of the American Recovery and Reinvestment Act, and even its passage is not guaranteed. However, similarities between the House and Senate approaches allow us to prepare for what the President may sign into law as early as next week.

In the interest of being prepared for funds being available to Indiana’s hospitals, IHA is suggesting that you quickly compile information on projects that could be eligible for grants or other funding assistance. Much of the health care-related funding may flow directly to providers (such as Medicaid dollars and most of the health information technology funding), but state governments may be provided discretion in certain areas. For example, the Senate-passed version of the ARRA appropriates $1.6 billion for “grants to make schools and hospitals, significant users of energy, more energy efficient” (see summary available on http://appropriations.senate.gov/). It is unclear exactly how it would be allocated, but it may be prudent to prepare for some sort of competitive grant process.

Mitch Roob, CEO of the Indiana Economic Development Corporation, has been asked by Gov. Daniels to coordinate the state’s management of stimulus dollars. IHA anticipates that once the final bill is known, we will contact members again with more details on (1) what kind of projects might be eligible for funding; and (2) what information is needed by IEDC or any other grant-making entities.

Based on reviews of the stimulus legislation, the following list is provided as a guideline for you to compile projects in these areas along with supporting information that would likely be needed. IHA cannot be sure that these projects will be eligible for any funding, but we simply want to be prepared. We will follow-up with a more formal survey after passage of any stimulus legislation and additional conversations with IEDC.

NOTE: These categories of projects are listed in the order of the likelihood of available funding.

• Energy efficiency or “green building” projects: Do you have “shovel-ready” energy efficiency or “green building” capital projects in the pipeline on which work could be underway within six months after receipt of federal funding assistance? If so, what phases have been completed and what would be the level of assistance required for completion?
• Health Information Technology: Do you have projects such as electronic health records or upgraded infrastructure/servers/systems in the pipeline? If so, what phases have been completed and what would be the level of assistance required for completion?
• “Brick and mortar” capital projects: Do you have “shovel-ready” traditional capital projects in the pipeline that could be underway within six months after receipt of federal funding assistance? If so, what phases have been completed and what would be the level of assistance required for completion?

Provisions Worth Noting in Senate Stimulus Deal
The Senate Appropriations Committee has released a summary of the stimulus legislation, and there are several health-related provisions worth noting. This summary is available on the Committee's Web page here: http://appropriations.senate.gov/.

The total amount appropriated for health information technology is $3 billion. This is significantly below the $20 billion in the earlier House version. The Senate summary also reports $1.1 billion will be given to the Agency for Healthcare Research and Quality, National Institutes of Health, and the Health and Human Services Office of the Secretary to evaluate the effectiveness of health care services. The House stimulus legislation appropriated $4.1 billion for similar research. In another area of the bill, $1.6 billion would be available in energy efficiency grants for schools and hospitals. More updates will be provided.

Leaders Ask Congress to Replicate Health IT Model
Leaders in Indiana are encouraging Congress to consider replicating Indiana’s Health Information Exchange model as it looks to invest billions in health IT infrastructure as part of the American Recovery and Reinvestment Act of 2009. IHIE provides the country’s best working model of a health information exchange— securely connecting 39 hospitals, 10,000 physicians, and more than 6 million patients. The exchange delivers lab results, reports, medication histories, and treatment histories, in real-time regardless of the hospital system or location. Studies have shown that efficient exchange of medical records among doctors and hospitals in the U.S. could save billions annually. Click here to read IHIE’s letter to Congress.

RAC Rollout to Proceed; Contract Protests Resolved
The Centers for Medicare & Medicaid Services has announced it will now continue with the rollout of the permanent Medicare recovery audit contractor program. The program had been on hold as a result of contract bid protests, which have now been resolved. Details on CMS’ plans to resume the program are pending and will be shared when available. IHA plans to schedule a RAC briefing in the near future.

Registration Now Open for Nurse Retention Briefing
Registration is now open for Engaging and Retaining Nurses: A Prescription for Redesign in Tough Economic Times. It is set for March 18 at the Hilton Indianapolis North. The program will provide Indiana’s nursing leaders with practical strategies that lead to: improved staff satisfaction and retention; improved quality of patient care; more effective care teams; and greater efficiency. The program will use the tested principles and processes of Transforming Care at the Bedside, a program of the Institute for Healthcare Improvement/Robert Wood Johnson Foundation. Presenters will share the evidence base that supports practical tools, techniques, and resources for improvement. To register, visit www.regonline.com/iha2009rnretention.

ECRI Issues High Priority Alert on Bassinet Warmers
ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving patient care, has issued a high priority medical device alert for several older models of infant radiant warmers. ECRI Institute recommends the removal of a series of warmer models manufactured by Borning and Hill-Rom. Complete findings and recommendations are posted for free public access on ECRI Institute's Web site in its Patient Safety Center.

Time Running Out to Register for Just Culture Program.
The registration deadline for the Just Culture Champion Training Session is Feb. 24. The program will be held March 3 at the Montage, Indianapolis. This training session will examine the Just Culture model—focusing on risk, system design, and the management of behavioral choices. The Just Culture Algorithm will also be introduced. The algorithm is a structured process for conducting an investigation of an event or near misses—identifying system contributions and assessing accountability for those involved. The session will be presented by experts from Outcome Engineering, the developers of the Just Culture Algorithm. Following the session, participating hospital teams will be ready to implement the just culture concepts learned during the session into their respective hospitals. To register, visit www.regonline.com/iha2009justculture.

The WHO Campaign for Safe Surgery turns into "The Sprint"

• On June 25, 2008 the World Health Organization launched its "Safe Surgery Saves Lives" campaign.
• On December 20, 2008, Don Berwick calls upon all hospitals participating in the IHI 5 Million Lives Campaign to also participate in "The Sprint" by adding "one more change at a breathtakingly short time" - "adopt and use the WHO Checklist in at least one OR in every hospital in the next 90 days."
• The Indiana Hospital Association recently posted on its "Patient Safety Update" webpage that it is supporting the campaign. "To participate, hospitals need only test the list in one operating room, by one surgical team, one time before April 1." It also says that Indiana is only one of a few states to have committed to testing the checklist.

The scope of the WHO's Checklist for Safe Surgery is broader than the Joint Commission's Universal Protocol to Prevent Wrong Site, Wrong Procedure and Wrong Person Surgery (tm).

Joint Commission's Universal Protocol: Universal Protocol

WHO's Checklist: WHO Checklist

WHO's website (with additional tools and resources): WHO Safe Surgery Website

IHI Campaign website: IHI Campaign Site

How long do you think it will be before the Joint Commission starts to adopt elements of the WHO's checklist?