Healthcare Administration

IL hospital must prove community benefit, or else

Wed, 11 Jul 2007 20:01:38 -0400

Of late, state and federal regulators have been challenging non-profit hospitals to prove they deserve their tax exemption. Hospital associations, health systems and individual facilities have responded by aggressively touting their estimates of the community benefit and levels of uncompensated care that they provide.

This exercise is important for all U.S. non-profits, but there's even more at stake for Mokena, Ill.-based Provena Health. The Catholic hospital chain has been fighting to keep its state property tax exemption in the face of claims it hadn't done enough. State's Department of Revenue Director Brian Hamer contends Provena Covenant Medical Center's 2002 charity care level, which he said represented less than 1 percent of its revenue, wasn't enough to merit its tax exemption. The Champaign County Board of Review pulled the property tax exemption in 2003, arguing the facility had been too aggressive in collecting money from indigent patients.

This year, Provena hopes to turn perceptions around. The chain says its community benefit efforts had $61.7 million in total impact on the 750,000 people served by its six hospitals and affiliated facilities. That includes $17 million in free care, $38.9 million in "non-reimbursed" services to Medicaid patients and $5.7 million in community services, hospital officials said. Now, let's see how this report goes down. If officials don't buy it, Provena could be in worse trouble.

To find out more about Provena's situation:
- read this Chicago Tribune piece

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CMS P4P project shows diabetes care savings

Wed, 11 Jul 2007 20:01:37 -0400

While the evidence for cost-savings seems a bit, well, ambiguous, CMS this week is trumpeting the results of the first year of its diabetes care P4P project. CMS has just completed the first year of a three-year demonstration project under which the agency is monitoring diabetes care provided by 10 large medical practices. Diabetes management is being measured by standards drawn from CMS's Doctor's Office Quality project. Under the terms of the demonstration, which was mandated by Congress, CMS is providing financial incentives to practices that save more than 2 percent over projected costs.

Based on these standards, Marshfield Clinic and the University of Michigan Faculty Group Practice, Ann Arbor, earned about $7.3 million, 80 percent of the $9.5 million they're thought to have saved Medicare. Meanwhile, all 10 participating practices met at least seven of 10 clinical benchmarks. Still, it's worth wondering why eight of 10 practices don't seem to have generated significant savings. Let's see what happens when Medicare begins measuring care for congestive heart failure and other conditions over the next few years.

To learn more about the project:
- read this Modern Healthcare article (reg. req.)

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Trend: Hospitals bring families into ICUs

Wed, 11 Jul 2007 20:01:35 -0400

Traditionally, hospitals have strictly limited families' contacts with seriously-ill patients in their intensive-care units. Of late, however, a small but growing number of hospitals are adopting a new model, under which hospitals invite patients to live with their vulnerable family members and assist in their care. This trend is spurred, in part, by a growing family-centered care movement backed by an expanding body of supporting research.

Emory University Hospital, for example, has added living quarters to its new neuroscience intensive care unit, adding chairs, beds, a sink, table and a Wi-Fi network in addition to communal bathrooms and showers and a common kitchen and lounge. Another example is Intermountain Health Care, which plans to open a new hospital with large intensive-care rooms that include pull-out sofa beds.

This approach isn't easy for everyone. Nurses and doctors may be forced to change their working patterns--some call this setting a "fishbowl"--as well as perform invasive procedures in the presence of family members. Patients may be flooded with visitors, forcing even these more-flexible units to set some limits. But initial results suggests families are pleased with this approach, which helps them feel comfortable with the entire care process.

To get more background on this trend:
- read this article from The Wall Street Journal (sub. req.)

Related Article:
Program fosters ICU provider, family communication. Report

Study: Nurse turnover not highest priority

Mon, 09 Jul 2007 20:01:38 -0400

While nurse turnover can cost hospitals as much as $5.4 million per year, hospital executives typically are working harder on other issues, including quality improvement, reimbursement problems and uncompensated care, a new study shows. The Pricewaterhouse Cooper study, which included data from 237 hospital respondents, found nurse and physician staffing were sixth and seventh, respectively, on a list of key issues cited. On average, executives reported temporary nurses were staffing an average of 5 percent of hospitals' nursing hours.

To get more data from the study:
- read this Modern Healthcare article (reg. req.)

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Case study: Nurses offer cross-language care

Mon, 09 Jul 2007 20:01:35 -0400

Virtually every hospital faces at least some issues in working with immigrants who don't speak English. That's particularly true in states that face a particularly large flow of new immigrants, like California. Hospitals there are responding with new programs to meet the steadily increasing demand.

At UC Davis Medical Center, for example, they're handling the problem by establishing a special program designed to connect bilingual nurses with patients who need them. Under the center's Transcultural Linguistic Care Nurse Program (known as TLC), bilingual nurses conduct admissions interviews, interpret for physicians and work with patients. These nurses add to the medical center's existing capabilities, which include use of hired interpreters, translating phone services and the use of non-clinical bilingual staff members. To date, only five nurses have been assigned to the program, but hospital executives hope to add more.

To learn more about these programs:
- read this piece from the Sacramento Bee

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Non-hospital MRSA more dangerous

Thu, 05 Jul 2007 20:01:37 -0400

While hospital-acquired methicillin-resistant staphylococcus aureus (MRSA) infections are nasty, a new MRSA strain emerging outside of hospitals is proving to be even more lethal. This newer MRSA strain, community-associated MRSA, is often spread in prisons and on athletic teams , both of which bring people into close physical contact and involve sharing personal items like towels, soap or even water, says Richard Wenzel, president of the International Society for Infectious Disease. What really ought to worry healthcare professionals is that this deadlier MRSA strain has begun to spread into hospitals, Wenzel warns. Fortunately, simple expedients like hand-washing can cut the spread of MRSA within a hospital substantially--as 85 percent of infections are spread from patient to patient by healthcare workers--and isolating known MRSA patients helps too, Wenzel notes.

To learn more about this trend:
- read this United Press International piece

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Critics doubt benefit of posting hospital prices online

Thu, 05 Jul 2007 20:01:35 -0400

While posting prices online is fine, it may not necessarily help patients choose the best value for their dollar, critics say. While lower prices may suggest a hospital is more efficient--and getting patients well faster--that's not necessarily the case, advocates note. In addition, the rash of hospital prices being posted vary widely; for example, some hospitals quote their median fee paid to contracted health plans, while others quote "sticker prices" that don't really give a sense of a patient's true out-of-pocket cost.

Not only that, such prices usually don't include quotes for both a procedure and the bundle of additional services that are delivered as part of the process. Ultimately, even experts have a heard time blending pricing information with quality data in a meaningful way, critics note.

To learn more about this trend:
- read this Associated Press article

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Case study: NYC hospital cuts noise

Thu, 05 Jul 2007 20:01:34 -0400

On at least one floor of Montefiore Medical Center, quiet reigns. Rather than enduring the incessant noise of beepers, squeaking carts and loud conversations, patients on the fifth floor of Montefiore enjoy near-silence. The newly low decibel levels are thanks to a program known as Silent Hospitals Help Healing, or SHHH. The program was started two years ago by the nurse manager of the floor, Elodia Mercier, when she noticed that patients' number one complaint was how noisy their stay was.

Now the floor, which has 34 beds and about 40 workers, has fixed squeaky wheels on med and food carts and installed sound-deadening ceiling tiles and curtains. Staff members are asked to wear soft-soled shoes, avoid loud hallway conversations and set their beepers to vibrate. Not only that, patients have the option of wearing headphones while watching television, which cuts down further on ambient noise. Within weeks of inception, the program reduced the noise level on the floor from a city street level of 90 decibels to a library-style level of 65 decibels.

To learn more about the program:
- read this article from The New York Times (reg. req.)

U of Pitt Med Center plans drug, device gift ban

Wed, 04 Jul 2007 20:01:38 -0400

The University of Pittsburgh Medical Center (UPMC) is poised to implement a new policy banning physicians and other employees from accepting virtually any type of pharma or device-maker freebies. If it moves ahead, UPMC would join a growing list of academic medical centers and other facilities that have instituted tight controls on such gifts. Employees and physicians who break the rules could face written reprimands and even loss of hospital privileges.

To address concerns raised by the plan's biggest critics--who say barring the acceptance of samples would harm poor patients--the school would look into setting up a voucher program giving patients access to meds at no cost to them. Only if the voucher approach failed would providers be allowed to make a special request for samples. The problem, critics say, is that such an approach could dramatically delay drug access by the poor and uninsured. Some institutions instituting similar controls, such as the Henry Ford Health System, have continued to permit physicians to accept samples under some circumstances.

To find out more about this trend:
- read this Pittsburgh Post-Gazette piece

Related Articles:
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Group: Few med schools free of pharma influence. Report

Three more heart transplant programs in jeopardy

Wed, 04 Jul 2007 20:01:37 -0400

Continuing its ongoing investigation of heart transplant programs, CMS has threatened three more programs with decertification. CMS has given San Antonio, Texas-based Christus Santa Rosa Hospital-Medical Center, Abbott Northwestern Hospital in Minneapolis and St. Vincent Indianapolis Hospital 30 days to submit corrective action plans. Meanwhile, a fourth heart transplant program at the University of Kentucky Chandler Hospital has agreed to give up Medicare funding entirely, at least for the time being, following the lead of eight other programs that have made the same decision.

Among the key issues troubling CMS is the low volume of procedures performed annually by the cited hospitals. In both 2005 and 2006, each of the four performed less than the minimum 12 heart transplants.

To find out more about the warnings:
- read this Los Angeles Times article

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