Welcome back to the January 2010 issue of the Indidge Advantage newsletter.
While we celebrate the coming of the new year, it has traditionally also been the time of the year to examine ourselves and the way we do things. What better time to step outside the box and adopt more efficient tools and methods. This is how we grow personally and how the organizations we strive for move forward into the next decade.
The first article is information you can use regarding the high performing organization we endeavor to become. The next article informs you of news from the Joint Commission on accreditation. The last article tantalizes you with the Senate healthcare reform bill that will reshape the industry.
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
by Janice Simmons, for HealthLeaders Media
This month marks the 10th anniversary of the publication of the Institute of Medicine's To Err Is Human—a study that put a new focus on how patient safety is addressed in the United States. Though the report served as a clarion call to healthcare organizations to promote safety, many in the healthcare industry would probably agree that more still needs to be done at the local level.
Earlier this week at a forum sponsored by Consumers Union's Safe Patient Project in Washington, DC, Richard Shannon, MD, chair of the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia, provided health leaders with some insights on how to move their organizations forward to becoming high-performing facilities that can effectively address patient safety concerns.
Healthcare in the U.S. today is not "a high-performing organization," Shannon said. But it could be.
Shannon, borrowing pages from colleague Steve Spear's book, Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win, suggests it could be different if healthcare organizations recognize—and try to change—a number of traits that hold them back:
- Many high-performing organizations "swarm and solve problems to build new knowledge—[where] problems are not things to be avoided," Shannon said. "They're learning opportunities." However, "in healthcare, we are the best work-around experts. We see problems every moment and absolutely do nothing about them . . . the antithesis of the high-performing organization."
- High-performing organizations tend to be "level" in structure—where individuals at all levels have a say. Many healthcare organizations, though, tend to be hierarchical—where decisions are made from the top down.
- High-performing organizations are constantly expanding the frontier of what they don't know. They must look for new ways and new ideas.
So what does this have to do with patient safety? Well, plenty. Before working at the University of Pennsylvania, Shannon was chief of medicine at Allegheny General Hospital in Pittsburgh, where he was instrumental in initiating a project that lowered central-line associated bloodstream infections and ventilator-associated pneumonia rates in the intensive care unit. He has continued with this work at Penn.
What he has discovered is that "in the end, the inability to understand in great detail how we do our work is the genesis" of many of the patient safety issues many healthcare organizations now encounter. Many times, the organization will look for the quick fix—hoping the problem goes away. "This characterizes one of the reasons why progress has been so slow," he says.
A new mindset needs to occur about patient safety. First, while it helps that patient safety is viewed as a priority, it is more important that it is seen as a "precondition of work," he says. "The foundation of quality is safety—and safety must be a precondition."
"There are hundreds of priorities that sit on my desk. If safety is one of them, it's in with the hundreds of others. But if it's a precondition, that means I begin work at 6:30 a.m. at the point of care asking 'did anything happen last night that could lead to the risk of someone getting a central line infection?’" he says. "That tells the workers that it's a precondition of coming to work."
Nurses need to be on the frontline with patient safety, he emphasizes. "It's fundamental," he says. "Nurses are the guardians of patient safety. They need to be empowered to do this. It's extraordinary what you can achieve when you partner with nurses."
Shannon recommends moving beyond data collected by the Centers for Disease Control and Prevention. This data generally does not deal with "fixing problems in hospitals." Instead, he suggests becoming a "deep observer of the current condition" within the healthcare organization.
For instance, it is important to know how a central line is "placed, maintained, and manipulated." And then, taking that knowledge and learning and "sharing it with everyone," he says. "As a leader, you must commit to fixing things that are there . . . to make sure [an infection] doesn't happen again."
And while comparative effectiveness has its benefits, it's not feasible when dealing with patient safety issues of waiting around five years or so for answers. "Safety is about making little changes at the point of care and then seeing if they worked," he says. This means listening to ideas of those on the frontline of delivering healthcare.
You may want to explain how a central line is to be "placed, maintained, and manipulated" by creating a Policy along with an accompanying Procedure and then sharing it with everyone by using our automated Policy and Procedure Management System. Call (480) 829-0479 x138 or e-mail Tom Reid for a demonstration.
Field review of proposed modifications to MS.01.01.01 (formerly MS.1.20)
At its November meeting, The Joint Commission Board of Commissioners approved the field review of proposed modifications to hospital medical staff standard MS.01.01.01 (formerly MS.1.20). The field review is available on The Joint Commission Web site and will be available through January 28, 2010 to provide all interested parties an opportunity to comment on the proposal. The proposed modifications were unanimously recommended by the MS.1.20 Implementation Task Force in March 2009 and subsequently supported by the leaders of the organizations represented among the Task Force members. An informal field review was conducted over the three month period ending on October 15. Hospitals are currently expected to be in compliance with Medical Staff standard MS.01.01.01 in the hospital accreditation manual. The current standard will remain in effect until further notice. There is an indefinite moratorium on the implementation of Element of Performance 19 of the current MS.01.01.01.. (Contact: Chuck Mowll, mailto:cmowll@jointcommission.org)
by Matthew DoBias for ModernHealthcare.com
The Senate healthcare legislation passed last week aims to reshape the U.S. healthcare system and the way hospitals, insurers and physicians do business.
The more than 2,000-page Patient Protection and Affordable Care Act, approved early Christmas Eve in a historic 60-39 vote, would greatly restructure the $2.5 trillion per year healthcare sector in just over a decade's time.
At a cost of roughly $871 billion over the next decade, the Senate's package is expected to extend coverage to 31 million Americans who currently go without it. Even so, it will leave another 23 million non-elderly residents without insurance—about a third-of who would come from the ranks of unauthorized immigrants.
The Congressional Budget Office, which analyzes legislation for its fiscal and real-world impact, predicts that 94% of legal U.S. citizens would have coverage by 2019. Of that, 26 million people would be covered through newly created insurance “exchanges,” and another 15 million would fall into expanded Medicaid and children's health insurance programs.
The bill essentially requires all legal residents to buy insurance, offering hundreds of billions of dollars in federal subsidies to help offset the cost. It also expands Medicaid to individuals making less than 133% of the federal poverty level. Those who don't purchase insurance would face a penalty of $95 starting in 2014, but increasing to $750 in 2016. Families would have to pay half the amount for children up to a cap of $2,250 for the entire family, according to the CBO.
While there is no mandate for employers to offer coverage, firms with more than 50 workers who do not offer coverage would be subject to a penalty of $750 for each full-time worker if any of those workers get subsidized coverage through the exchange. Under the bill, the exchange would include private health plans and could include two national or multi-state plans operated under contract with an office that already oversees selected federal health plans.
For their part, insurance companies would have to accept all individuals regardless of pre-existing conditions beginning in 2014 and could not vary premiums to reflect differences in enrollees' health.
By and large, much of the cost of extended coverage would come from reductions in federal dollars to the Medicare and Medicaid programs. For starters, the bill reduces the annual updates to Medicare's payment rates for most fee-for-service sectors, except physicians, by about $186 billion over 10 years. Additionally, the bill will effectively gut the Medicare Advantage program, moving participating plans to a form of competitive bidding, resulting in about a $118 billion cut.
The bill creates a so-called Independent Payment Advisory Board, which would hold sway over Medicare payment formulas. Under the legislation, the board would make annual recommendations to the president, Congress and private entities on actions they can take to improve quality and constrain the rate of cost growth in the private sector. Its Medicare recommendations are non-binding in years where Medicare growth is below the targeted growth rate. The board will develop its first recommendations in 2013 for implementation two year later.
Even though the hospitals sector struck a deal with key lawmakers and the White House itself, they're nevertheless in line for payment reductions under a reformed healthcare system. For instance, hospitals will see a major reduction in the federal dollars they receive for treating patients who can't pay the full amount of their bills. The Senate's legislation cuts disproportionate share funds by $43 billion under the assumption that the bill will expand coverage to those who currently don't have it.
The legislation also creates a pilot hospital value-based purchasing program in 2013, where a percentage of reimbursement would be tied to performance. If successful, it could be expanded. Inpatient rehabilitation facilities and long-term care hospitals will also move toward such a system.
The bill is loaded with other pilot programs and system studies. Under one, hospitals in 2013 could volunteer to receive payments for an entire episode of care rather than under the piecemeal inpatient prospective payment system, or IPPS. The bundled payment system will also be expanded to other provider types as well. It also establishes a Center for Medicare and Medicaid Innovation, which will be charged with finding new ways to improve the delivery and payment of care.
Hospitals also face new penalties. In 2012, for instance, hospitals would see their reimbursement cut for certain types of readmissions.
For physicians, a late amendment to the bill removed a 0.5% increase in Medicare reimbursement for 2010 – a move lobbied for by the physician community who wants to see a longer fix. Lawmakers said they would start work on such a measure starting early in January. A separate bill passed earlier this month allows for a more substantial re-working of the Sustainable Growth Rate formula.
The bill also begins to look at other ways doctors can get paid. Pilot programs will be created to help move physicians towards providing more integrated care, as well as docking Medicare payments—starting in 2014—for those who do not report on certain quality measures.
A key objective of the bill is to bolster the ranks of the primary care workforce. The legislation includes a raft or new funding and measures aimed to encourage doctors to move into primary care . And in a measure to help increase transparency, the legislation requires HHS to develop a “Physician Compare” web site where Medicare beneficiaries can compare measures of physician quality and a patient's perception of care.
Another provision authorizes the release and use of standardized extracts of Medicare claims data.
Additionally, the legislation will move federally qualified health centers toward a prospective payment system.
Join us Wednesday, January 27, 2010 from 11:00 AM - 12:30 PM MST for a free educational webinar. Just click on the register button below or if this does not fit your schedule , send Tom Reid an email at tom.reid@indidge.com or call him now at (480) 829-0479 Ext. 138 to schedule a web demo that better fits your schedule.
One day a housework-challenged husband decided to wash his sweatshirt.
Seconds after he stepped into the laundry room, he shouted to his wife, "What setting do I use on the washing machine?"
"It depends," she replied. "What does it say on your shirt?"
He yelled back, "DENVER BRONCOS."