Welcome to the October issue of the Indidge Advantage newsletter.
Can you believe it! It is almost Halloween time when there will be ghosts and goblins making their way through your neighborhood once more.
Actually what is really scary, is that with out just 10 basic patient safety reforms, 85,000 lives could be lost according to our first article by John Commins. Now that is scary!
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
by John Commins
The consumer activist group Public Citizen says it has 10 basic patient safety reforms that could save 85,000 lives and $35 billion annually.
The report "Back to Basics," analyzes the results of several studies of treatment protocols for chronically recurring, avoidable medical errors. Most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.
The financial toll of failing to follow accepted safety procedures is astounding, PC says. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion, and preventable adverse drug reactions $3.5 billion.
"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," says David Arkush, director of Public Citizen's Congress Watch division. "As the largest investor in the nation's healthcare system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements."
Public Citizen proposes that healthcare providers:
- Use a checklist to reduce avoidable deaths and injuries resulting from surgical procedures (this would save $20 billion a year)
- Use best practices to prevent ventilator-associated pneumonia (this would save 32,000 lives and $900 million a year
- Use best practices to prevent pressure ulcers (this would save 14,071 lives and $5.5 billion a year)
- Implement safeguards and quality control measures to reduce medication errors (this would save 4,620 lives and $2.3 billion a year)
- Use best practices to prevent patient falls (this would save $1.5 billion a year)
- Use a checklist to prevent catheter infections (this would save 15,680 lives and $1.3 billion a year)
- Modestly improve nurse staffing ratios (this would save 5,000 lives and $242 million a year)
- Permit standing orders to increase flu and pneumococcal vaccinations in the elderly (this would save 9,250 lives and $545 million a year)
- Use beta-blockers after heart attacks (this would save 3,600 lives and $900,000 a year)
- Increase use of advanced care planning (this would save $3.2 billion a year)
Public Citizen also proposes five steps to ensure near-universal adoption of these reforms:
- The federal government should leverage its $750 billion annual investment in healthcare to compel providers to use proven patient safety practices. HHS can enact many reforms through the regulatory process. Congress could ensure rapid adoption by including instructions to HHS in legislation.
- Congress should require HHS to take responsibility for accrediting providers to receive Medicare reimbursements. At present, the federal government delegates most accrediting authority to the Joint Commission, which derives its income from the very hospitals it oversees and denies accreditation to less than 1% of these hospitals.
- Congress should make significant financial investments to increase the country's supply of nurses and set federal minimums of acceptable nurse-to-patient ratios.
- Congress should require mandatory reporting of adverse events, including requiring hospitals to institute strong internal reporting, and creating whistle-blower protections for healthcare workers. National reporting of the most serious medical errors is largely left to the Joint Commission. However, that organization estimates that it learns of only about one-tenth of 1% of serious medical errors despite its stated requirement that doctors disclose all errors to patients.
- Congress should ensure that the requirements for hospitals to report doctor discipline and maintain viable peer review processes are followed. Hospitals have been required since 1990 to report to the federal government cases in which doctors are suspended for more than 30 days. But nearly 50% of hospitals have never reported a single disciplinary action.
by Philip Betbeze
If you've not heard the buzz surrounding Atul Gawande's recent New Yorker article, "The Cost Conundrum," you've either been out of the country or you've been following the Michael Jackson death soap opera too closely.
Let's just say that the good doctor's efforts have struck a chord. Even the president has mentioned the article in his efforts to get Congress to pass a healthcare reform bill.
Gawande's work to present the healthcare cost disparity in narrative form has caught the attention of many who believe healthcare's costs are out of control and that its growth profile is completely unsustainable. He found that tiny McAllen, TX, boasts higher healthcare costs than any other statistical area in the country, save Miami, which has much higher staffing and living costs. And the outcomes aren't any better.
Not one, not two, but three influential people gave speeches last week at the American Hospital Association's annual Leadership Summit in which they prominently referenced the article as a window into the problem with healthcare costs. I've been to other conferences around the country too this summer, and if the article is not the first topic people bring up in casual conversation about healthcare, it's the second.
But so what?
What amazes me about these speeches and conversations is not the fact that the article has received so much acclaim. It is well-written, and Gawande, a physician himself, does an admirable job of searching for other possible explanations to McAllen's cost problem than the conclusion to which he's ultimately drawn:
Are people there are unhealthier than those in other areas of the country? No.
Do hospitals and physicians in McAllen provide exceptionally better healthcare than anywhere else? No.
Is it malpractice insurance costs? No.
Is there overutilization of medical services? Absolutely.
People are waving this article around like it's some revelation. They're rightly using it as a call to action for healthcare providers, government, and payers to coordinate care and use evidence-based protocols to prevent so many unnecessary tests and surgeries. But where have they been for 20 years?
The Dartmouth Atlas of Health Care has been around for more than that long. It says the essentially same thing as Gawande's article, except it's much more detailed, depending on reams of Medicare cost data to tell essentially the same truth.
Gawande concludes that local variability is rooted in the overuse of services. But it can be easier to make fun of McAllen than it is to turn the mirror on yourself. You don't have to wait for healthcare reform to take action. Here are a few ideas:
- Do you know where your community stands in the Dartmouth Atlas or other global efficiency metrics?
- Within your hospital or medical group, have you done an analysis of key diagnostic procedures and orders, particularly to identify gross outliers of overuse by procedure or by provider/group?
- Have you fixed those outliers within your control?
- Have you collaborated with other providers in the community to analyze any troubling patterns?
- If there are community health issues (high rate of diabetes, obesity, smoking, etc.) that contribute to overuse of services, have you initiated a critical review of current community wellness programs and explored ideas for future interventions?
Coordinating care is hard. Developing evidence-based medicine protocols is hard. Ordering tests and surgeries is relatively easy, and it pays a heckuva lot better.
It's no surprise that healthcare costs so much. Outside of some commercial plans that pay close attention to such things, what incentive do doctors and hospitals have not to over-test or over-cut their patients? What incentive do they have to tell their patients "no" when "yes" is so much easier, not to mention more lucrative?
Meanwhile, many folks who are against evidence-based medicine or comparative effectiveness research want to raid the national healthcare cash register with one hand while they use the word "rationing" as an obscenity to belittle those who want to do something to fill in the bottomless pit that healthcare spending has become.
We've known about vast waste in healthcare spending for more than 20 years now.
When are we going to actually do something about it?
by Anne Zieger
With healthcare providers across the U.S. working like maniacs to meet the upcoming deadline for switching from ICD-9 to ICD-10 coding--a closer-than-it-seems October 1, 2013--CMS has extended a helping hand with a new fact sheet explaining key details of the changes that must take place. (Sadly, it's unlikely this advice is going to make the switch any faster or less expensive, but it's always nice to get information straight from the enforcer's mouth.)
The CMS fact sheet offers an overview of the structural differences between the code sets, giving several examples of the far-greater richness the ICD-10 code set provides when describing a patient's condition. For example, it notes that while ICD-9-CM describes "Mechanical complication of other vascular device, implant and graft" with one code (996.1), ICD-10-CM breaks the same general condition into 156 distinct codes, including "Breakdown (mechanical) of aortic (bifurcation) graft (replacement)" and "Displacement of other vascular grafts."
It also lists a dozen recommendations for planning implementations of ICD-10, including identifying stakeholders, assessing the impact of the switchover, developing education and training plans for employees at all levels, and developing an IT systems change implementation with testing and "go-live" dates.
To review the fact sheet:
- download it (.pdf) from CMS
Join us Wednesday, October 7, 2009 from 11 AM - 12:30 PM PDT 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.
An efficiency expert was delivering a seminar on time management for a company's junior executives. He concluded the session with a disclaimer: "Don't attempt these task-organizing tips at home," he said.
"Why not?" he was asked.
"Well, I did a study of my wife's routine of fixing breakfast," he replied, a little embarrassed. "I noticed she made a lot of trips between the refrigerator and the stove, the table, and the cabinets, each time carrying only one item. So I said to her, 'Honey, I notice that you make a lot of trips back and forth carrying one item at a time. If you would try carrying several things at once you would be much more efficient.'" He paused. "Did that save time?" one of the executives asked. "Actually, yes," the expert answered, "It used to take her 20 minutes to fix my breakfast. Now I get my own in 7 minutes."