Welcome to the February 2010 issue of the Indidge Advantage newsletter.
We often put off, what deep down in our heart, we know we should do. Our first article this month highlights the case for a well managed policy and procedure system and what can happen to the organizations that keep deferring that decision to a later time.
The second article brings you more news from the Joint Commission.
The third article raises the question of how hospitals would fare under proposed reimbursement plans.
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
by Dan Bowman
Aside from communication breakdowns, one of the most common patient safety errors at hospitals involves a simple failure to follow the organization's own policies and procedures. Whether it's adhering to certain medication administration protocols, verifying staff and temp staff competencies or sticking to assessment and monitoring protocols, too often, hospital staff and physicians fail to fully comply, as a spate of recent, costly cases so clearly documents.
Thirteen hospitals this week were each fined an average of $50,000 by California's health department after inspections revealed life-threatening compliance issues. One hospital, John F. Kennedy Memorial Hospital in Indio, was slapped with at least four fines of $25,000 each due to deficiencies in medication administration, patient monitoring and competencies verification procedures.
Other hospitals assessed administrative penalties by the state included:
- St. Jude Medical Center in Fullerton, where a man being treated for a heart attack died after his heart monitor had been disconnected -- and went unnoticed by nurses. According to an internal investigation, the patient's heart monitor alarm also wasn't loud enough for staff to hear. The hospital was fined $50,000.
- California Hospital Medical Center in Los Angeles, where a woman who had been misdiagnosed as having an ectopic pregnancy--who wasn't even pregnant--was treated with chemotherapy drugs that suppressed her immune system, causing sores to appear on her mouth, throat and skin. That hospital was fined $50,000.
At John F. Kennedy Memorial Hospital, two nurses failed to follow protocol in the case of a five-month old infant who was brought to the emergency room in June 2008 with a fever of 105.4 degrees and a an abnormally high heart rate. The first nurse, a contract nurse hired through an agency, was found to have no clinical competencies, and failed to reassess the patient after initially recording temperature, heart rate and oxygen saturation level. (Official policy called for continuous reassessment.)
The second nurse, a newly hired graduate who also failed to have any clinical competencies and who had no advanced cardiac life support or pediatric advanced life support training, documented the infant's temperature on three separate occasions, but never recorded the patient's heart rate or oxygen saturation level. None of the other vital signs were recorded until a third nurse took over.
The hospital was fined $25,000 for the incident, and also was fined three more times for other failed compliances.
To read about all of the hospitals fined:
- Read the state's press release and its reports on inspections at each hospital.
New survey agenda development process
Beginning in 2010, The Joint Commission will implement a new, more collaborative process for developing the survey agenda. The survey agenda will be similar to what organizations have historically seen and experienced; what has changed is that The Joint Commission will inform organizations before their survey about the on-site survey length and number of surveyors. Also, the organization can work with surveyors during survey to determine the best timing for the various survey activities. The new process will be more sensitive to the time demands of the health care organization and its staff during the on-site survey while still providing a thorough survey of the organization. All accreditation customers due for survey in 2010 will experience this revised agenda process (the new process does not affect certification reviews):
- The Joint Commission will send an e-mail to the organization to confirm the programs to be surveyed and to direct the organization to its Joint Commission Connect extranet page for a list of survey activities for each applicable accreditation program (the list is a planning tool that can be used with the Survey Activity Guide); and a program-specific document list that identifies initial materials surveyors will request to review at the onset of the survey.
- Shortly after an organization receives its e-mail, it will receive a phone call from its account executive to confirm that it has reviewed and understands the information on its extranet site. At this time, the account executive will provide the anticipated number of days and number of surveyors that will be assigned to the organization’s on-site survey.
- On the first day of the on-site survey, surveyors will work with the organization to confirm that the schedule considers the organization’s operations and needs.
- During the survey, organizations will work with surveyors to determine the best time for scheduling survey activities so they coincide more effectively with patient care and administrative operations. It is important to note that survey activities are not changing.
(Deborah Ryan, dryan@jointcommission.org or your account executive)
by Philip Betbeze
I was talking to a health system CEO the other day, who was angry at the deals being struck between leaders of industry lobbying groups and government leaders. Never mind that these "deals" are just handshake agreements not to oppose the president or Congress' idea of healthcare reform-whatever shape it eventually takes.
Angry may be a strong word. Let's just say he was dissatisfied. We talked about the $80 billion in dubious cost cuts over the next 10 years that drugmakers agreed to with President Obama earlier this year in order to buy not only their silence, but their support, in the face of healthcare reform. It's hard to argue that that deal hasn't since been exposed as a not-so-well-hidden gift to drugmakers.
We then talked about the $155 billion in cuts the main hospital lobby, the American Hospital Association, agreed to in principle in July, which doesn't seem nearly as lucrative, as I'll get to in a minute. In short, it doesn't look like hospital negotiators did quite as well.
Finally, we talked about the one big lobbying group that hasn't made a deal on healthcare reform: insurers. Predictably, that industry has become the villain du jour in the raucous healthcare reform debate we've been following all year. Hospitals have avoided that fate, but at what cost? My purpose is not to defend health insurers, but to ask whether any "deal" agreed to under pressure is really a good deal.
Take the hospitals. In return for agreeing not to oppose healthcare reform, the AHA, representative of the nation's more than 5,000 hospitals, said its members would collectively accept $155 billion in reimbursement cuts over 10 years in return for a reform plan that would insure effectively all of the currently uninsured-presumably through a combination of a mandate requiring all citizens to carry health insurance and a public option health plan that would facilitate that coverage.
The announcement of the deal came after administration heavies not-so-quietly suggested that $200 billion in cuts would be about right, causing hospital representatives to gulp-hard.
The health system CEO I was talking to was angry that there was no provision to keep such a public option from ratcheting back reimbursement further once it's in place. He was off about that. In fact, the deal contains a promise that "public option" reimbursement rates would not reach the low level of Medicare and Medicaid reimbursement rates, which, depending on whom you believe, come in at somewhere near 90% and 60%, respectively, of the cost of providing that care.
Further refinements of the bills in both houses revealed that the public option would have to negotiate rates with hospitals in a similar way that commercial plans do now. Fine. But nothing in the intervening time period has spelled out at what level the public plan might think is a fair reimbursement. Never mind the difficulties of negotiating with a payer that can effectively put you out of business, or, at the very least, make life very difficult for those who don't like what the government plan is offering.
So back to the question I asked in my headline. What if all your reimbursement came from Medicare? I'm guessing you wouldn't like it very much, considering that all I've heard over the years is how Medicare significantly underfunds the cost of care in its reimbursements, leaving hospitals to cross-subsidize by negotiating deals with commercial insurers that pay better. That's a hidden tax that we all currently pay for the fact that government reimburses poorly.
But if healthcare reform passes, and even if the public option pays you as much as 99% of costs, much higher than Medicare, you still come out way behind over time. And that was the crux of my friend's point.
And don't count on commercial insurers to continue making up the difference. Why should they? They haven't made a deal with the president, after all.
Join us Wednesday, February 10, 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.
A little girl asked her father, "How did the human race come about?"
The father answered, "God made Adam and Eve and they had children and so all mankind was made."
Two days later she asks her mother the same question.
The mother answered, "Many years ago there were monkeys, and we developed from them."
The confused girl returns to her father and says: "Dad, how is it possible that you told me that the human race was created by God and Mom says we developed from monkeys?"
The Father answers, "That's simple, honey. I told you about the origin of my side of the family, and your mother told you about her side."