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New News - Class 5

Putting Hospitals Track Record Online

As part of a transparency trend in the health care industry with the government, insurance companies and other institutions focusing on holding providers accountable for results along with an attempt to bolster its reputation and win customers, Northwest Community Hospital is the first hospital in the Chicago area to disclose extensive information online about its quality of care.  Patients' ratings are being posted along with data about care for heart attacks and heart failure, hospital acquired infections, adequacy of nursing staff and other measures. 

Leading medical centers use We sites to offer information about how often they deliver recommended treatments and how often people die in their care.  Experts warn consumers to  discuss findings with their physicians because there are no standards governing the disclosure of quality information and therefore there is of the potential for bias. 

In light of public scrutiny combined with consumers paying more for health care out of their own pockets, doctors and administrators are more likely to feel a sense of urgency to improve care. 

At Medicare's Hospital Compare site (at www.hospitalcompare.hhs.gov), for several years the government has posted data about how hospitals treat patients with heart attacks, heart failure, pneumonia, and stroke.

The challenge for the hospital in posting its own data on its own site was figuring out how to translate complex medical jargon into useful language, explain what it means, and display the information.  According to a senior advisor at the federal Agency for Healthcare Research and Quality which developed a set of standard measures of health care quality being used by many hospitals, if its too complicated folks won't use it. 

Chicago Patient Safety Forum executive director commented that he likes it but why are they reporting only one of the National Patient Safety Goals when there are 16; and the hospital's response is that those numbers wee not ready when the site went up but will be posted when available.  Another comment by the Midwest Business Group on Health claimed the site needs better explanations of what terms mean and questions where all the data comes from and how it was collected.  The hospital claims its a learning experience as they learn more about what users want.  A senior medical director at Hewitt Associates, which advises employers about health-care benefits would have liked the hospital to have included information about the volume of medical services it performs as research shows that institutions doing a higher volume of procedures such as heart surgeries typically have better results.  The hospital claims it intends to put up data about key services such as cardiology, orthopedics, and cancer during the next year.  Experts say it is important that good science underlies the quality measures and that all results be published, good and bad, .i.e. you have to report everything.

Some hospitals do not want to discloses quality information and worry about the burden of collecting the data, public's reaction and the resources they might need to fix problems that come to light.  (Source:  "Hospitals is 1st in Chicago area to put its Track Record Online" by Judith Graham, Chicago Tribune, September 16, 2007, page 1 and 29).

Employer Aims to Improve Workers' Care by Training Primary Care Physicians to Follow Guidelines
 

American Airlines launched a program to improve quality of care for
about 55,000 employees in the Dallas-Fort Worth area. Under the
program, about 100 primary-care physicians will be evaluated on how
well they follow national guidelines for the treatment of heart
disease, stroke and diabetes over a 12-month period.

(1)  They will be compared with other physicians in UnitedHealthcare's north Texas network and with the National Committee for Quality Assurance's Health Plan Employer Data and Information Set.

(2)  In its second phase, the project will provide feedback to the physicians and resources to help them follow the guidelines.

(3)  The third phase will include reporting results and recognizing participating physicians. "This differs from our existing wellness programs in that we are working directly with area physicians and our health-plan administrator to proactively manage the care of at-risk patients," director of health strategies at American Airlines.  (Source:  Modern Healthcare 9-19-05)
 

Disease Management

The Congressional Budget Office (CBO) has prepared an analysis whether disease management programs can reduce the overall cost of health care and how such programs might apply to Medicare. It examines peer-reviewed studies of disease management programs for specific conditions: congestive heart failure, coronary artery disease, and diabetes (selected in part because they are highly prevalent among Medicare beneficiaries) and broader reviews of the relevant literature published in major medical journals.

According to CBO's analysis, there is insufficient evidence to conclude that disease management programs can generally reduce overall health spending while noting that such programs could be worthwhile even if they did not reduce costs.  CBO's analysis focused on the question of whether those programs could pay for themselves. CBO claims that disease management programs that propose to decrease use of acute care services might offset the costs of the screening, monitoring, and educational services is appealing, but much of the literature on those programs does not directly address health care costs and instead usually focuses on the processes of care or on intermediate measures of health, from which an overall impact on spending cannot reasonably be inferred. The few studies that report cost savings do so for controlled settings and generally fail to account for all health care costs, including the cost of the intervention itself.  The CBO's analysis states that if disease management programs were applied to broader populations, the reported savings might not be attainable, and the programs could even raise costs.  A few studies indicate that disease management programs could be designed to reduce overall health costs for select groups of patients (at least in the short term), but little research directly addresses the issues that would arise in applying disease management to the older and sicker Medicare population..

The CBO analysis also looks at how health outcomes affect both the quality of life and the utilization of health care. The quality of life is difficult to measure but seeks to encompass both physical and emotional well-being and has particular importance in cost-effectiveness analyses--which often report costs per "quality-adjusted life year" to capture changes in quality as well as in years of life.  Health care utilization, such as hospital admissions and emergency department visits, reflects the number of acute episodes experienced by patients. A complete economic analysis would take into account the costs of those acute services and expenditures for other types of care that might substitute for hospital based care.

 See (good document to see - see chart and definitions used in CBO's analysis):  http://www.cbo.gov/showdoc.cfm?index=5909&sequence=0

Medical Guidelines

"I have seen some studies that looked at which guideline a provider will follow," says Kenneth S. Fink, MD, MPH, the director of the evidence-based practice centers program at the Agency for Healthcare Research and Quality (AHRQ). "As expected, different providers follow different guidelines. Often they will look to their specialty society, more so than they would look to other national renowned bodies, like the American Cancer Society or the U.S. Preventive Services Task Force." AHRQ conducts systematic evidence-based reviews often used by other groups to develop their own guidelines, such as medical specialty societies and the Preventive Services Task Force.

"If it is a health insurer who is recommending that a guideline be followed, then a physician is going to question who in the health plan's organization specifically created it," says Peter Ubel, MD, director of the program for improving health care decisions at the University of Michigan and VA Medical Center in Ann Arbor, and professor of medicine at the University of Michigan. "If there is no involvement of patients or a community representative, then physicians may be suspicious. If it looks like only people interested in the bottom line are making the guideline recommendation, then it looks suspicious. You need people from different sides of the street to come up with a guideline."  "Who should be setting the guidelines for the use of ophthalmology services in people with diabetes, for example?" continues Ubel. "The ophthalmologist groups have their interest; the consumer diabetes groups have their own interests. So should it be the U.S. Preventive Services Task Force? The problem is that guidelines are not always consistent between all the groups."

Time:  "The greatest barrier to me is that I'm so busy doing my daily work that it's hard for me to relearn my daily work," says Lowenhaupt, the Capgemini consultant. "So I see doctors who were excellent clinicians 20 years ago, but they're still practicing that 20-year-old medicine and it no longer cuts it."

Inertia:  You continue to do what you have always done because its worked in the past, that is how you know how to do it, and why should you change.  However, consider the following example:  you have treated hypertension with calcium channel blockers first because that is how you have always done it; though current guidelines recommend diuretics and beta blockers as first-line therapy.  "We are talking about a 10-year adoption cycle," says Lowenhaupt. "Look at how long it took for physicians to finally start giving aspirin to their patients who survived a myocardial infarction."  

Apprentice Method Physicians Learn Medicine Can Result in Regional Differences:  Also, consider the way physicians learn medicine through the apprentice model of shadowing more experienced physicians.  This methodology gives rise to regional variances in diagnosis, treatment, and performance of procedures.

Payment:  Insurers can create barriers to from helping physicians use medical guidelines by not paying for management time or research time. Insurers tend to pay for physicians to have a face-to-face encounter with a patient in an office, not to write a quick e-mail to follow up with a patient.

(Source:  “Can Physician and Health Plan Get Together Over Guidelines?” by Tony Berberabe, Managed Care Magazine (September 2004)

Rehab Stays Drop

The average length of stay at rehabilitation hospitals dropped 8 days from 20 days in 1994 to 12 days in 2001, largely due to reimbursement changes.
(Modern Healthcare 10-12-04)

Hospital Quality Measures

The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) signed an agreement to work together in completely aligning current and future common Hospital Quality Measures in their condition-specific performance measure sets.  The current Hospital Quality Measures are included in the Joint Commission's ORYX® Core Measures and CMS' 7th Scope of Work Quality of Care Measures on heart attack, heart failure, pneumonia and surgical infection prevention.  CMS and the Joint Commission released and made available on their websites a common measures specification manual, which includes a data dictionary, measure information forms, algorithms and other technical support information. (JCAHOnline, 10-04)

Outcomes Measurement

The Joint Commission issues an award it claims is named for the physician regarded in health care as the "father of outcomes measurement," the Ernest A. Codman Award showcases the effective use of performance measurement by health care organizations to improve the quality and safety of health care.  Per the Joint Commission, in 1910, Dr. Codman proposed a system for physicians and hospitals to track every patient treated to determine whether individual treatments were effective. Dr. Codman's "end results" system emphasized the important utility of outcomes measurement for performance improvement.  (JCAHO News 10-12-04)

Return to Managed Care Approach to Control Rising Costs:  Evidence-Based Guidelines  

Harvard Pilgrim Health Care, Wellesley, Mass., said doctors are ordering so many MRIs, CT scans, and other expensive imaging tests that it is returning to a traditional style of managed care to control these soaring costs.  The plan covered 130,362 advanced imaging tests last year, an increase of 62% in two years, costing the plan $73 million, and so the plan has decided to require doctors to approve all nonemergency advanced imaging tests with a company hired by the plan to evaluate whether the tests meet "nationally recognized, evidence-based guidelines."  For years prescription drugs were the most explosive portion of medical budgets for health plans and now for many health plans, radiology costs are growing faster than costs for prescription drugs.  (Modern Healthcare 2-27-04)

Federal Initiative for Hospitals to Track Quality

Federal government's voluntary quality reporting initiative for hospitals has 10 quality measures being tracked that relate to three clinical areas - heart attack, heart failure and pneumonia.  (Modern Healthcare 2-20-04)

Joint Commission International Establishes European office

Joint Commission International (JCI) announced the opening of an international branch office located in Europe in Ferney-Voltaire , France , near Geneva , Switzerland , will permit JCI to better support the needs of European clients, and improve coordination of JCI quality and patient safety initiatives with other international agencies such as the World Health Organization and International Hospital Federation. (JCAHO 10-19-04)

Updating HEDIS Health Plan Measures Proposed by NCQA

The National Committee for Quality Assurance (NCQA) proposed five new measures of health plan performance that assess quality of care and physician advice on common health issues, such as back pain and post-heart attack care.  The new measures include the persistence of clinicians in providing beta blocker treatment following a heart attack; use of imaging studies in lower back pain; drug therapy in rheumatoid arthritis; and for older adults, advice on physical activity, as well as prevalence of screening for glaucoma.  NCQA proposes retiring from five measures used since the mid-1990s in its Health Plan Employer Data and Information Set (HEDIS) because no useful definition of good performance exists for those measures which include several involving maternity and childbirth, such as: rates of Caesarean section and of vaginal birth after Caesarean section; and length of stay for maternity patients and newborns.  (Modern Healthcare 2-27-04)

Kaiser Call Centers

Recalled California Gov. Gray Davis in one of his last acts in office, signed a law requiring HMO employees who give medical advice over the telephone to be licensed medical professionals.  Call-center operators will still be allowed to schedule appointments and ask basic questions about a person's condition, but the information must be passed to a nurse who will decide if and when a caller should see a physician. The basis for the new law comes from the 1996 case of Margaret Utterback, a 76-year-old woman who died from a ruptured aortic aneurysm after having repeatedly phoned Kaiser Permanente's call center in Hayward , CA .  Operators failed to tell her to go directly to the ER.  Kaiser employs about 1,200 operators in its Northern California call center and paid a $1 million fine for the incident.  The operators use scripts written by medical professionals to evaluate callers' symptoms and conditions.  In 2002, Kaiser's call centers came under further scrutiny for a now-discontinued pilot program that awarded bonuses to operators who limited physician appointments and spent less time on the phone with patients.  (Modern Healthcare 10/21/03 )

Readmissions - Why is there so much variance in health care? 

The Pennsylvania Health Care Cost Containment Council Pennsylvania report includes data from 168 hospitals on risk-adjusted mortality, lengths of stay, readmission rates and hospital charges.  Readmission rates in general and length of stay varied substantially among hospitals.  For example, the risk-adjusted average length of stay for diabetes with amputation ranged from 4.9 days to 17.7 days.  Hospitals had 12,000 readmissions attributed to infections and other often-preventable complications in 18 treatment categories from Oct. 1, 2001 to Sept. 30, 2002 .   The readmissions resulted in $410 million in additional charges and 93,000 extra patient days.  Hemorrhagic stroke was associated with the highest rate of readmission at 7.7% and poisoning and toxic effects of drugs had the lowest rate at 0.9%.  (Modern Healthcare 10/29/03 )

Health Outcomes

The Wisconsin Collaborative for Healthcare Quality issued its first report on healthcare outcomes at the consortium's hospital, clinic and health plan members, based on 42 quality measures.  Among the six hospitals reporting data on aspirin prescriptions for heart-attack patients, prescribing rates at discharge ranged from 94% to 100%, compared with a national average of 88%.  Among five hospitals reporting the percent of heart-failure patients assessed for left ventricular function, assessment rates ranged from 72% to 100%, compared with 78% nationally.  (Modern Healthcare 10/21/03 )

ICD-9 to ICD-10

A Blue Cross and Blue Shield Association report concluded that the healthcare industry would have to absorb up to $14 billion in implementation costs to move to a proposed new coding system called  ICD-10-CM and would cause a large-scale disruption.  The coding system would replace a coding system in use for more than 20 years known as ICD-9 that assigns codes to medical observations and treatments.  The report comes at the same time as a recommendation in favor of the coding shift by a subcommittee of
the National Committee on Vital and Health Statistics, an advisory body to HHS.  The recommendation goes to the full committee for vote next week. If accepted, the committee would advise HHS to begin the rulemaking process for adoption of the ICD-10 update.  The Blues claimed that benefits of the coding switch were uncertain and unproven and called for a "stakeholder commission" to develop a national plan for standards.  (Modern Healthcare 10/30/03 )  

New Jersey Senate Unanimously Passes Patient Safety Bill

The New Jersey Senate unanimously passed a patient-safety bill that
would require hospitals and other healthcare practitioners to report
medical errors.  (Modern Healthcare 2-24-04)

Patient Safety

According to a report by the California HealthCare Foundation a California mandate that hospitals develop medication-error reduction plans has prompted healthcare facilities in the state to embrace patient safety as a top priority.  The 2000 law requires only one
error-reduction technology to be in place by January 2005 however hospitals' plans for technology and process change go far beyond the statute's minimum requirements as hospitals on average intend to deploy three technology tools by then.  According to plans submitted in 2002, 157 hospitals said they would implement computerized order-entry
and medication-alert systems within 15 months. More than 100 planned to
automate the medication administration record and 52 were working on
bar-code systems at the point of care.  (Modern Healthcare 10/29/03 )

Patient Safety Initiatives in Massachusetts

Several initiatives are under way in Massachusetts to research and prevent medical errors,
including a state-backed clearinghouse for patient safety education, training and best practices.  According to the state Department of Public Health incident reports and patient complaints at Massachusetts hospitals rose 76% from fiscal 1996 through 2003.  In 2003, patient falls was the most commonly reported incident accounting for
378 of a total of 757 incident reports received by the department.  The most common patient complaint were related to quality of nursing services 73 of  571 consumer complaints, and 55 were related to quality of medical care. (Modern Healthcare 10/29/03 )

Isolated Patients Likely to Get Less Care

Per JAMA study:  Hospital patients put in isolation because of contagious infections may be more likely to suffer bedsores, falls and other preventable complications. (Modern Healthcare 10/8/03 )  

FDA Requiring Bar Codes on drugs

Food and Drug Administration (FDA) is issuing a final rule requiring bar codes on the labels of thousands of human drugs and biological products in order to promote higher quality care by helping protect patients from preventable medication errors and also to reduce the cost of health care by using information technology.   FDA estimates that the bar code rule, when fully implemented, will help prevent nearly 500,000 adverse events and transfusion errors over 20 years.  New medications covered by the rule will have to include bar codes within 60 days of their approval; most previously approved medicines and all blood and blood products will have to comply with the new requirements within two years.  

IT Grants to improve healthcare

The Foundation for eHealth Initiative, Washington , announced a $3.9
million grant program to provide seed money for community efforts that
use IT to improve healthcare.  The thinking is that electronic communications using common health data standards can help patients receive necessary and timely medical treatment, guard against medical errors, incorrect prescriptions, adverse drug events, help officials identify and respond to public health threats more quickly.  (Modern Healthcare 10/21/03 )

9-22-03:  Per Modern Healthcare, "Quality of care Varies Widely Across U.S.":  A study on medical outcomes by HealthGrades, Lakewood, Colo. compiled information involving 5,000 U.S. hospitals using Medicare data adjusted for severity of illnesses for the years 2000 through 2002.  The study on 26 procedures and diagnose at the nation's hospitals found that healthcare quality varies widely state by state, with better-performing facilities generally in Northern or less populous states and worse-performing facilities generally in Southern states.  The study found that New York ranked the highest for quality of hospitals, followed by Florida, Ohio, Michigan and Maryland.  A patient undergoing angioplasty in Texas was 55% more likely to die than a similar patient in New York, and the chance of dying of a heart attack in Mississippi was 49% greater than in Colorado.

The rankings were based on results of five procedures and diagnoses in the areas of angioplasty, heart-attack care, heart bypass surgery, heart failure and pneumonia. In other findings, quality-improvement efforts at the state level were tied with higher quality for coronary bypass surgery. Among the best performers were New Jersey, New York, Pennsylvania, Michigan, Massachusetts and Virginia, which have well-established efforts by Medicare Quality Improvement Organizations or support profiling physician outcomes

Disease Management Programs

HHS Secretary Tommy G. Thompson announced today that HHS is seeking
proposals to improve the quality of care provided to certain Medicare
beneficiaries.  The program will be capitated.  Disease management programs that promote patient-centered, multi-disciplinary approaches to care; encourage the use of sophisticated information technology to support the provision of evidence-based care; and focus on the improvement of care processes and patient outcomes.

Cost of Diabetes

According to a study by the American Diabetes Association (ADA) published in the March issue of Diabetes Care the annual cost of diabetes in medical expenditures and lost productivity went from $98 billion in 1997 to $132 billion in 200.  In that time, the direct medical costs of diabetes more than doubled, from $44 billion in 1997 to $91.8 billion in 2002.  According to American Diabetes Association President Francine R. Kaufman, M.D.:"Eliminating or reducing the health problems caused by diabetes through factors such as better access to preventive care, more widespread diagnosis, more intensive disease management, and the advent of new medical technologies could significantly improve the quality of life for people with diabetes and their families while at the same time potentially reducing
national expenditures for health care services and increasing productivity
in the U.S. economy."

A new Web site, www.diabetesatwork.org, helps companies assess their need for diabetes education and management at their worksites, provides guidance on choosing a diabetes friendly health plan, and more than 30 lesson plans and fact sheets that promote diabetes education management among employees.  The Web site is hosted by the Washington Business Group on Health (WBGH) and was developed in collaboration with the National Diabetes Education Program Business and Managed Care Work Group, the National Business Coalition on Health and the American Association of Health Plans.

Quality of Care Study

2-18-03:  A new study in today's Annals of Internal Medicine compared care for colorectal cancer, hip fracture and heart attacks from 1993 to 1995 of Medicare beneficiaries based on three measures of quality -- mortality over five years, functional status and patient satisfaction  between the groups of beneficiaries in regions with the highest per-capita spending at the end of life who received 60% more care than beneficiaries in the lowest-spending region.  This study indicates those who receive more care under the program do not necessarily end up in better health and that if the United States could safely achieve spending levels equal to those of the lowest-spending regions, Medicare could reduce its costs by 30%.  The researchers concluded that "Efforts to reduce spending should proceed with caution, but policies to better manage further spending growth are warranted." 

See the articles by Fisher, Wennberg, Stukel, Gottlieb, Lucas, and Pinder:  The Implications of Regional Variations in Medicare Spending.  Part 1 - The Content, Quality, and Accessibility of Care.  The Implications of Regional Variations in Medicare Spending.  Part 2 - Health Outcomes and Satisfaction with Care.   (February 18, 2003, Vol. 138 No. 4)

Holding Doctors Accountable for Quality of Care

Massachusetts lawmakers will be considering a bill, believed to be by its supporters the first of its kind in the nation, to punish physicians who repeatedly offend or intimidate patients and colleagues.  This bill represents a start of a national movement to hold doctors accountable for quality of care.  The new bill directs the state medical board to create a list of behavioral measures that doctors would be judged every two years such as rudeness, demeanor with nurses, punctuality, behavior with patients and vulgar remarks.  Interviews with physician colleagues and nurses would play a central role and those flunking could have their hospital credentials revoked.  Repeated failures could lead to suspended medical license and all discipline would be open to appeal.  

Using Technology to Cut Costs, Improve Quality of Patient Care

12-16-02:  Per an article in Chicago Tribune (12-16-02, Business Section, pages 1 and 5)"Monitors to Give Doctors Remote Assistance" with subtitle "Technology is Seen as Cost-Cutter":  Advocate Health Care in Chicago will install video cameras in intensive care units so specialist physicians can supervise patient care around the clock by remote control.  This technology uses software to track the various patient vital signs that ICU equipment normally monitors such as blood pressure, heart rate, and body temperature providing early alerts to potential problems.  Many studies have documented that constant monitoring of critical care patients by specialists will reduce mortality and speed recovery.  The problem is there are not enough trained specialists in the country to provide such care using traditional methods.

Advocate will begin using this technology in two hospitals by spring and plans to have all 212 ICU beds in its eight Chicago area hospitals covered by remote control by first quarter 2004.  The technology, developed and marketed by a firm founded by physicians at John Hopkins Medical Center, Baltimore based Visicu Inc., is intended to improve patient care and save money by avoiding many complications that often afflict patients and require expensive care.  Advocate expects the technology will result in reducing patient deaths by as much as 25% and reduce the average ICU stay by 15% to 20% and cut average treatment costs by more than $2000 per patient.  Costs of using Visicu's technology vary but generally installing equipment to monitor 50 to 100 patients can cost $2 million to $3 million and staffing the monitoring center with physicians and nurses can cost another $2 million annually.

Why would Advocate use this new technology

Dr. Lee Sacks, Advocate's chief medical officer after learning about the technology a year ago went with a dozen doctors and nurses to see the first operating example of the technology at a hospital in Virginia.  They determined they need to do this as fast as possible.  Advocate would use this new technology:  (1) to market itself to patients; (2) help the hospitals attract ICU nursing staff - as there is a nursing shortage and ICU nurses may have less experience than they once did and even be new grads; (3) Leapfrog Group, an association of large employers that finance health insurance for their employees has identified as a standard that enriched patient monitoring by critical care specialists as the greatest single step hospitals can take to reduce patient death and suffering.

12-18-02:  NEW BIRTH REPORT - MORE MOMS GET PRENATAL CARE

HHS report shows a significant increase in the number
of women receiving prenatal care, especially among Hispanic and black
women.  The report shows that 83% of women received timely (in the first trimester) prenatal care in 2001, up from 76 percent in 1990 and only 1% of women did not receive any prenatal care in 2001.  During this time period, timely prenatal care increased among all race and ethnic groups, but was particularly evident among Hispanic and black women.
See:  "Births: Final Data for 2001"  on CDC's National Center for Health Statistics web site at www.cdc.gov/nchs

Wisconsin Hospitals Providing Quality Data in 2004

Per Modern Healthcare (12-2-02):  "Beginning in 2004, Wisconsin will require all 125 hospitals in the state to provide state employees with quality data, such as hospital infection rates, complications and overall performance. The project is likely to become broader. Hospital officials and the Wisconsin Hospital Association are working on plans to make the data available to anyone, not just the 213,000 people insured through the state. Hospitals, however, are concerned that consumers will misinterpret outcomes data. State officials support releasing the information as a goad to improve quality".

Focus on Quality tied to Physician Compensation

Per Center for Studying Health System Change, "Tracking Report" November, 2002:  "Both health plans and physician practices sometimes tie specific financial incentives to overall compensation to influence physicians' clinical decision making.  These incentives include profiling - comparing a physician's pattern of medical resource use with those of other physicians - results of patient satisfaction surveys and quality of care measures such as rates of preventive care."  There are signs that the new ways to influence physicians' clinical decision making today are focusing on quality, i.e. rewarding physicians who meet certain care standards such as Pay for Performance initiative launched recently by six California insurers where physicians receive additional payments for meeting quality measures.  Physicians for whom profiling or patient satisfaction surveys are tied to compensation are substantially more likely to report that these tools have a "moderate" to "very large" effect on their practice of medicine as compared to physicians for whom these tools are not linked to compensation.

Health Care Costs Not as High as Feared for Aging Baby Boomers

1-8-03:    According to research published in the Journal of Gerontology sponsored by the National Institute on Aging, based on an analysis of 25,954 elderly people enrolled in Medicare from 1982 to 1998:  Overall, the average monthly healthcare expenditure per person in the group was $720 in 1998 dollars. In the month before death, the cost for people aged 65 to 74 averaged about $7,580, while the cost for those 85 and older was $5,254.  This study indicates that aging baby boomers will not run up healthcare costs as they reach their 80s and 90s by as much as had been feared.

11-25-02:  The following is excerpted from a HHS Release on Patient Safety Data:

HHS announced a $5.9 million two year contract awarded through the Agency for Healthcare Research and Quality (AHRQ) to improve the department's collection and reporting of patient safety data with KEVRIC Company, Inc, of Silver Spring, MD. , a small women-owned business.  The project to integrate existing data collection systems will ultimately be expanded to include non-HHS entities such as state health departments, accrediting entities such as the Joint Commission for the Accreditation of Healthcare Organizations, the Department of Defense, the Department of Veteran's Affairs and systems in other countries such as the United Kingdom.

HHS currently operates a number of systems to collect information that helps to monitor health care safety; compliance with existing regulations on blood products, devices, drugs; and safety of patients in Medicare-funded institutions.  This contract will lead to the development of a system to link existing reporting systems and integrated data from the National Healthcare Safety Network, operated by the Centers for Disease Control and Prevention (CDC) and the drug, biologics, vaccine and devices adverse events reporting systems that receive reports from doctors, nurses, and other healthcare providers, run by the Food and Drug Administration (FDA).

This contract represents a significant step towards the goal of a more complete systems integration, automated data reporting and standards-based solution for health data exchange.  The common system will ultimately include all safety-related systems operated by the CDC, FDA, Centers for Medicare & Medicaid Services (CMS).  Together with AHRQ, these agencies comprise the HHS Patient Safety Task Force, established by Secretary Thompson, to study how to implement a user-friendly internet based patient safety reporting format.

Study Projects Demand for Hospital Beds

11-6-02: According to a study by Solucient:  Demand for beds in U.S. hospitals is projected to increase 46% over the next 25 years due to aging baby boom generation, increasing life expectancy and rising fertility rates.  The study claims acute-care admissions will increase 41%, or by 13 million admissions, during that period and as a result, hospitals will add an estimated 238,000 beds. Inpatient demand will grow fastest in Western and Southern states and more slowly in the Midwest and Northeast. 

Cancer Incidence Data 

11-18-02:  Per HHS:  Produced jointly by the Centers for Disease Control (CDC) and Prevention and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries, this report provides state-specific and regional data for cancer cases diagnosed in 1999.  See:  The full report is available at www.cdc.gov/cancer/ and www.seer.cancer.gov/statistics

Working to Improve the Process of Measuring and Reporting on Health Care Quality

10-30-02:  Per Modern Healthcare:  In its third report on healthcare quality the Institute of Medicine called on the federal government to play a lead role in developing clinical standards and taking other major steps to improve quality in the industry. The IOM recommended that the six federal healthcare programs:  Medicare, Medicaid, the State Children's Health Insurance Program, the Defense Department's Tricare, the Veterans Health Administration and the Indian Health Services, develop standard performance measures to help the industry's multiple "stakeholders." The industry has struggled without "clear, consistent signals" on how to assess and improve quality, the report said.

HHS responded to the IOM report, "Leadership by Example: Coordinating Government Roles in Improving Health Care Quality," and stated that the report will be a basis for discussion within HHS and the federal Quality
Interagency Coordination (QuIC) Task Force.  The QuIC is comprised of
representatives of all of the federal agencies with health care
responsibilities.  Since its creation in 1998, the QuIC has helped to ensure
that quality improvement efforts are coordinated across the entire
government.

According to HHS:  The IOM report, prepared in response to a request from Congress, emphasizes the need for greater consistency in measuring the performance of health care providers across programs, ensuring that standards are valid and reliable, standardizing performance measures and reporting information to consumers in a way that will help them make better choices about their care -- all of which are priorities for HHS and other federal agencies involved in providing health care services.

Thompson also cited a number of other HHS programs as examples of how the Department is working to improve the process of measuring and reporting on health care quality, including:

10-28-02:  According to a study in today's issue of the Archives of Internal Medicine, most physicians believe that reducing medical errors should be a national priority but they are much less likely than the public to believe quality of care is a problem.  

10-7-02:  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) revamped its accreditation process focusing on the provision of safe, high quality healthcare. The "Shared Visions-New Pathways" initiative is to be implemented over the next one-and-one half to two year. The changes include seven new approaches, or "pathways," that include requiring healthcare organizations to conduct mid-cycle, self-assessments to evaluate their own compliance and develop correction plans for deficient areas and substantial consolidation of the standards to reduce paperwork and documentation burdens. According to JCAHO president, Dennis S. O'Leary, M.D., the new accreditation process "shifts the focus from survey preparation to focusing on operations and internal systems that directly impact the quality and safety of care."

10-2-02:  The Joint Commission on Accreditation of Healthcare Organization issued a Root Cause Analysis Matrix in which a detailed inquiry into certain areas is expected when conducting a root cause analysis for the specific type of sentinel event.  For example looking at: Suicide, Medical Error, Procedure Complications, Wrong Site Surgery, Treatment delay, Restraint Death, Elopement Death Assault/ Rape Homicide Transfusion Death and Infant Abduction and looking at:  Behavioral Assessment Process, Physical Assessment Process, Patient Identification Process, Patient Observation Procedures, Care Planning Process, Continuum of Care, Staffing levels, Orientation & Training of Staff, Competency Assessment/ Credentialing, Supervision of Staff, Communication with Patient/ Family, Communication among Staff members, Availability of Information, Adequacy of Technological Support, Equipment maintenance/ Management, Physical environment, Security systems and Processes, Control Medications: Storage/ Access and Labeling of Medication.

9-25-02:  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) through its Joint Commission Resources (JCR) announced the launch of a database that offers hospitals practical examples to meet accreditation requirements related to patient assessment, patient care, staff competency, performance improvement, environment of care, pain management, and patient rights and responsibilities.  An example of good practices survey questionnaire for REVIEW FOR DOCUMENTATION AND APPROPRIATENESS OF CARE can be seen at: http://www.jcrinc.com/goodpractices.asp?durki=2780&site=40&return=2779

Per Modern Healthcare (10-4-02):  HMO decisions were reversed in 37% of California appeals.  According to the state Department of Managed Health Care, an independent panel of doctors found that in 1,701 of consumer cases filed last year under the state's Independent Medical Review law, California HMOs incorrectly denied care on the grounds that it was medically unnecessary or experimental. This review law went into effect Jan. 1, 2001. The California Association of Health Plans claim the findings indicate that HMOs usually make the right decisions and that the number of complaints is small compared with the number of Californians who file healthcare claims every year.

Study of Chronic Conditions

8-14-02:  According to National Survey Details Americans' Experiences with Health Care for Chronic Conditions. Press Release, August 14, 2002. Agency for Healthcare Research and Quality, Rockville, MD.:  New data from the Agency for Healthcare Research and Quality (AHRQ) indicate that 23 percent of Americans aged 18 and older report that they have high blood pressure. The self-reported data, which come from AHRQ's Medical Expenditure Panel Survey (MEPS), also indicate that 10.3 percent report that they have heart disease; 9.1 percent, asthma; and 6.2 percent, diabetes.  These new measures will enable researchers to perform in-depth analyses on the quality of health care received by Americans and will be included in the National Quality Report, which will be published for the first time in 2003.

See press release at: http://www.ahrq.gov/news/press/pr2002/chroncon.htm

See MEPS' statistical brief at: http://www.meps.ahrq.gov/papers/st5/stat05.htm

Patient Safety

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) specified six patient-safety goals and 11 specific actions as the first and most important steps providers should take to cover activities to eliminate surgical mistakes such as operating on the wrong site and to improve clinical alarm systems, patient identification, caregiver communication, and use of high-alert medications and infusion pumps.

Nurses

Study suggests saving lives based on patient to nurse ratio

10-22-02:  Per Modern Healthcare:  A study to be published in JAMA tomorrow by researchers at the University of Pennsylvania School of Nursing, based on 1998-1999 data from 168 acute-care hospitals in Pennsylvania indicates "2% of patients died within 30 days of admission, but among patients with major new complications, the death rate rose to 8%. About 23% of patients experienced a major complication not present at admission".  This study suggests changing the patient-to-nurse ratio to eight patients per nurse from four would result in about a 30% increase in mortality, the researchers said."  According to this article, "The association of nurse-staffing levels with the rescue of patients suggests that nurses contribute importantly to surveillance, early detection and timely interventions that save lives," they said."

In regards to this study, per NIH 10-22-02:  On a national scale, staffing differences of this magnitude could result in as many as 20,000 unnecessary deaths annually.  The findings are contained in the article "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction," and appear in the October 23-30 issue of JAMA.  The research was funded by the National Institute of Nursing Research (NINR), NIH, part of the U.S. Department of Health and Human Services.  

For more information about nursing research see:
http://www.nih.gov/ninr

Aggressive Marketing by Pharmaceutical Company Impacts Physicians

Per Chicago Tribune (7-10-02):  A woman in Florida received a months supply of Prozac without her request as part of an aggressive marketing ploy.  She filed suit for invasion of privacy and the Florida attorney general has gotten involved.  Florida's attorney general issued subpoenas to Eli Lilly & Co., Walgreen Co., a local hospital and four health professionals to see if any laws were broken when some people received unsolicited Prozac through the mail.  The attorney general is looking into whether the parties engaged in unfair trade practices by using patients' trust and confidence in physicians and pharmacists to assist pharmaceutical companies because this would be a violation of the states Deceptive and Unfair trade Practices Act.  The names of the four medical group practitioners were referred to the Department of Health to see if their actions in the Prozac case violated any of Florida's Medical Practices Act.

Per Modern Healthcare (6-28-02):  According to the 2001 annual report of the U.S. Organ Procurement and Transplantation Network, the Cleveland Clinic transplanted hearts in more adults during the late 1990s than any other transplant center in the nation with the best results overall.

U.S. Supreme Court Case - Re:  ERISA Preemption

Per Chicago Tribune (6-21-02):  On 6-20-02 the U.S. Supreme Court upheld  that an Illinois law that allows people to turn to an outside reviewer when their HMO rules that a proposed treatment is unnecessary.  This ruling is significant because it goes to the issue of preemption in which HMOs had successfully relied on for numerous years to claim that the Employee Retirement Income Security Act of 1974 ("ERISA") preempts state law such as the Illinois HMO Act.  According to the U.S. Department of Labor, about 57 percent of private sector workers, about 58 million people, get their health insurance through benefit plans covered by ERISA.

The insurance industry has been fighting the current system of state-governed external reviews and health plans have argued that divergent laws raise costs and claim that they are not opposed to external review but want a federal standard.

According to Modern Healthcare (6-20-02):  Debra Moran approached her doctor in 1996 with pain and numbness in her right shoulder and her primary-care physician recommended that Moran's insurer, Rush Prudential HMO, approve surgery by an unaffiliated specialist. Rush denied the request claiming that the procedure was not medically necessary and proposed that Moran undergo a different procedure with a Rush-affiliated physician.  As allowed under Illinois' HMO Act, Moran made a written demand for an independent medical review of her claim.  A state court ordered the review, and the panel found the treatment necessary.  Rush again denied the claim.  While the suit was pending, Moran had the surgery recommended by her primary-care physician and amended her complaint to seek reimbursement. Rush moved the case to federal court, arguing that the amended complaint involved a claim for ERISA benefits.  A district court opinion treated Moran's claim as a suit under ERISA and denied it on the ground that ERISA pre-empted the HMO Act. That ruling was reversed in the 7th Circuit, which the Supreme Court upheld.  Justice David Souter, writing for the majority, claims federal law says nothing about the right to second opinions and he was joined by Justices John Paul Stevens, Sandra Day O'Connor, Ruth Bader Ginsburg, and Stephen Breyer.  In the minority opinion, Justice Clarence Thomas wrote that the ruling "undermines the ability of HMOs to control costs, which, in turn, undermines the ability of employers to provide healthcare coverage for employees." He was joined by Chief Justice William Rehnquist and Justices Antonin Scalia and Anthony Kennedy.

See:  Rush Prudential HMO, Inc. v. Moran etal.; certiorari to the united States Court of Appeals for the Seventh Circuit, No. 001021 - Argued January 16, 2002 - Decided June 20, 2002

The U.S. Supreme Court today in a 5-4 decision ruled that Illinois can force insurers to submit to the decisions of an outside review panel.



In doing so, the court upheld a 7th U.S. Circuit Court ruling that the Employee Retirement Income Security Act of 1974 does not pre-empt Illinois' HMO Act.







"The great danger is that with costs already skyrocketing, employers navigating varying state laws may be forced to reconsider whether they will offer health insurance for their employees," said Donald Young, M.D., president of the Health Insurance Association of America, Washington.



Federal law, however, says nothing about the right to second opinions, said Justice David Souter, writing for the majority. He was joined by Justices John Paul Stevens, Sandra Day O'Connor, Ruth Bader Ginsburg, and Stephen Breyer.







Patient Protection 

Per HHS News Release (6-13-02):  About 22 million Medicaid beneficiaries, or 58 percent of all Medicaid enrollees, were enrolled in managed care programs at the end last year.  HHS Secretary Tommy G. Thompson today issued a final regulation to give Medicaid beneficiaries enrolled in managed care plans the same types of protection that participants in private plans would receive under patient rights' legislation now under consideration in Congress.  The regulation guarantees Medicaid beneficiaries access to emergency room care, a second opinion when needed, a timely right to appeal adverse coverage decisions and other patient protections. Under the new regulation, states have significant flexibility to decide how best to implement patient protections and use managed care in their Medicaid plans.  This rule also will change the federal requirements governing payments under state managed care programs, moving away from a formula using fee-for-service payments to a requirement that the methodology be actuarially sound. Under the rule, beneficiaries will have the following rights:

The regulation becomes effective Aug. 13, 2002, and states and health plans must come into full compliance within a year.
The final regulation will be published in the Federal Register June 14 and will be available online at http://www.hcfa.gov/medicaid/omchmpg.htm. 

Medical Guidelines

6/10/02:  The National Asthma Education and Prevention Program
(NAEPP), issued an update of selected topics in the Guidelines for the
Diagnosis and Management of Asthma.  

Consider Purpose of Guidelines:

Coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, NAEPP convenes an expert panel as needed to ensure that the asthma guidelines reflect the latest scientific advances.  The guidelines were first published in 1991 and revised in 1997.  "NHLBI is committed to ensuring that asthma patients benefit from the latest research findings," said NHLBI Director Dr. Claude Lenfant. "Asthma is one of the most common chronic health conditions in the United States, and the number of Americans who suffer from asthma continues to rise. It is essential that they are treated according to the best available scientific evidence, and this update brings such evidence to clinical practice."  The NAEPP was established in March 1989 to reduce asthma-related illness and death and to enhance the quality of life of people with asthma. Today, 40 major medical associations and voluntary health organizations, plus numerous federal agencies, comprise the NAEPP Coordinating Committee.

Consider Costs:

According to the National Center on Health Statistics, 11 million Americans
reported having an asthma attack in 1998, including 3.8 million children.
One of the leading causes of disability and lost productivity, asthma is
also responsible for 5,000 deaths each year in the U.S. NHLBI estimates that the annual direct and indirect costs of asthma were $12.7 billion in 2000.

See:  http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

6/5/02:  The following is an example of how providers are trying to distinguish themselves as seen in an advertisement in the Chicago Tribune:  Advertisement for Rush-Presbyterian-St. Luke's Medical Center indicating that "Rush is now the only medical center in Illinois for adults and children to win the prestigious Magnet Award from the American Nurses Assocaition.  The Magnet Award is widely recognized as a critical benchmark for hospitals.* It means we've met the toughest possible standards for nursing care.  That makes the people we care for winners, too.  Because research shows that patients in Magnet Award hospitals are significantly more satisfied with their care - and have better outcomes.  From now on, you'll see the Magnet Award pin on nurses at Rush.  And that's a very big deal for anyone concerned about the quality of health care in Illinois."  * The Wall Street Journal, 3/2/01, 5/30/2002; The New York Times, 4/16/02.  (Emphasis added)

Buzzwords for quality:  Based on the "Quality Driven Disease Management:  Closing the Quality Gap" seminar being sponsored by the 7th Annual Disease Management Congress, directives from the Institute of Medicine (IOM) Report, “Crossing the Quality Chasm,” seminar topics include Baldridge, safety, leadership, quality improvement, comorbidities, patient satisfaction, Six Sigma, evidence based medicine, innovation, effectiveness, performance excellence, efficiency and cost savings.

5-13-02:  President of The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Dennis O'Leary, M.D., testified May 8 before the House Committee on Energy and Commerce Subcommittee on Health about strategies to reduce medical errors.  As a way to proactively reduce medical errors, O'Leary referred  to recently implemented JCAHO patient safety standards and claimed that the standards place the responsibility on organization leaders to "create a culture of patient safety" and that the standards also "create the expectation that unanticipated outcomes will be communicated to patients and/or their families." The standards emphasize the need for teamwork and effective communication among responsible caregivers. 

   See: http://www.jcaho.org/sentinel/oleary_test.html

Re:  Coding 

5-7-02:  Per AMEDNews.Com (5-13-02):  Andre S. Chen, MD, a family physician at the Austin, Texas Diagnostic Clinic, a 130-doctor multispecialty group. was struck by the inefficiency of learning the federal evaluation and management documentation guidelines so he could bill appropriately.  The complexity of the guidelines made it impossible for him to memorize them, forcing him to use paper templates or to guess what elements he needed to document higher level E&M services. He studied how to program computers and wrote a handheld-based software that he could use as a handy coding and documentation reference tool and then set up StatCoder.com. The "virtual" software company sells the coding software Dr. Chen created to improve his own efficiency and he earns about $60,000 this year from it.  One doctor who used this approach said:  "Many doctors are frightened of using the higher-level codes because of concern of getting audited, investigated or accused of fraud and abuse, and they tend to knock the level down," and this system allows you to get more back with an appropriate level of coding.  Another doctor user of this system cautions:  "This program will not teach the newbie all he or she needs to know about coding, but the person who is fairly comfortable with coding and even an expert coder will find this program useful as a quick coding reminder and coding reference...I still use it several times a week to remind myself of what is necessary for the different levels of service and different [practice] settings...I believe it has helped me document better and also code more accurately."

Medical Group Report Cards Online in California

5/16/02  Per Modern Healthcare:  California plans to add data from a consumer survey on medical groups to grade the quality and service of HMOs to a state-sponsored Web site launched last year. The state’s Office of the Patient Advocate runs the site and posts the results of the office’s annual survey of the state’s 14 largest HMOs. By late September, the office will add information about 81 medical groups serving more than 10 million commercial and Medicare HMO enrollees, or about 72% of the insured market in California. The information will come from the state’s 2002 Consumer Assessment Survey, which tracks consumers’ assessment of access to care, patient-doctor communication, quality of care and preventive-care counseling. 

See updated report card at www.opa.ca.gov.

5/16/02  Per New England Journal of Medicine:  A study of neonatologists found that o.  This is based on 

4/29/02:  A pilot project part of Department Health and Human Service (HHS) is the Nursing Home Quality Initiative aimed at improving the quality of nursing home care nationwide. "By generating and publishing quality data, we are both helping consumers to make decisions that best meet their needs and creating market incentives for nursing homes to further improve quality," DHHS Secretary Tommy G. Thompson said. The data for the pilot project involve nine quality measures in two categories-six for chronic care patients and three for post-acute care patients.

See quality data at Medicare's consumer Web site, at:  http://www.medicare.gov, or call Medicare's help line, 1-800-MEDICARE.

6/5/02:  Joint Commission Resources (formerly known as Quality Healthcare Resources) was established in 1986 by the Joint Commission on Accreditation of Healthcare Organizations in an effort to improve the
safety and quality of care in the United States and in the international
community through the provision of education and consultation services and
international accreditation.

2-6-02: From Chicago Tribune (2-6-02):  Section1 , page 10, "Conflicts of Interest by Doctors Reported" subtitle "Drug Firms' ties to Experts Cited" indicates that there is a growing concern of bias, not necessarily dishonesty, in the potential of conflict of interest of having medical experts writing medical guidelines without disclosing conflicts of interest, such as financial.  This article states that "Clinical practice guidelines are intended to present a synthesis of current evidence and recommendations by expert clinicians - for example, what course of drugs to prescribe for pneumonia."  This article cites a survey published in the 2/5/02 Journal of the American Medical Association indicating that "nearly 9 out of 10 medical experts who wrote the guidelines other doctors use to treat their patients had financial relationships with drug companies when they wrote them".  The diet drug Fen-Phen scandal was used as an example of why there is a push by major medical journals to have uniform disclosure policies.  According to this article, the New England Journal of Medicine published a study showing the the diet drug Fen-Phen could lead to a potentially fatal lung condition and a commentary published in the same issue minimized the findings, though readers were not told that both authors of the commentary were paid consultants for companies that made and distributed similar drugs.

1-21-02: The Leapfrog Group is a consortium of Fortune 500 companies and other private and public health care purchasers that provides health benefits to more than 28 million Americans and spends approximately $52 billion on health care annually.  On January 17, 2002, the Leapfrog Group released the initial results of an ongoing survey of hospital patient safety practices. The survey found, among other things, that, of the 241 hospitals submitting responses, 3.3% currently had computerized physician order entry (CPOE) systems in place, while 30% had plans to implement CPOE systems by 2004. Also, 10% of the respondents had fully implemented the practice of staffing their intensive care units with intensivists and an additional 18% reported plans to implement the practice by 2004.  The Leapfrog Group was established after the 1999 Institute of Medicine report, To Err is Human, that makes the reduction errors a top United States priority  

Per JCAHO press release on 1/16/02:  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has become a partner with the Leapfrog Group.  According to the Joint Commission has begun work with Leapfrog leaders to pursue the identification of a specific set of ICU-related outcome and process measures. These measures may eventually be used to supplement or even replace the current Leapfrog measures which recommend that hospitals have board-certified or board-eligible intensivists.  More than half of Joint Commission accreditation standards address patient safety requirements. Standards issued in 1999 require the internal definition,
reporting, and analysis of adverse events in accredited health care organizations and the implementation of indicated improvements. New
standards that were implemented last year encourage the creation of a
culture of safety in hospitals, set forth expectations for the identification and redesign of error prone systems, and require the disclosure of unanticipated outcomes to patients and/or their families.

See:    http://www.leapfroggroup.org.

The Leapfrog Group lists as their Links for Patient Safety Organizations:

The Agency for Healthcare Research and Quality    www.ahrq.gov

The Institute for Safe Medication Practices     www.ismp.org 

The Institute of Medicine    www.iom.edu

The National Forum for Health Care Quality Measurement and Reporting (NQF)    www.qualityforum.org

National Patient Safety Foundation    www.npsf.org

Partnership for Patient Safety    www.p4ps.org

The Quality Interagency Coordination Task Force (QuIC)    www.quic.gov

U.S. Pharmacopoeia    www.usp.org

    A framework for providers, policymakers,and the public to use in evaluating proposed patient safety and quality standards. Commissioned by the Healthcare Leadership Council, the American Hospital Association, and the Federation of American Hospitals, the report outlines four criteria for assessing proposed standards: whether the standard is relevant and appropriate, whether the standard was developed using appropriate methodology, whether the standard can be implemented by all hospitals, and whether the standard promotes continuous quality improvement.  "In order to ensure that standards are enduring and fair, and
not 'just the latest fad,' standards must be data based, achievable, cost
effective, and reflect the views of all constituencies," the report
concluded.  See:    http://www.fahs.com

Best Practices

12/3/01:  Per amednews.com:  A recent study by coauthor Vincenza Snow, MD, a Wayne, Pa., internist published in the September/October issue of Effective Clinical Practice, there is a 24% noncompliance rate in the use of best practice procedures by physicians treating patients with type 2 diabetes, but researchers say this result does not represent a deficiency in care but, instead, a deficiency in the definition of what constitutes best practices.  "Our data suggest that failure to follow guidelines is not necessarily explained by 'bad doctors,' or forgetfulness; rather, noncompliance may reflect valid questions about the usefulness and applicability of a best practice to an individual patient," the researchers stated in their report.

Improving Patient Safety

From HHS Press Release 10/11/01:

HHS Secretary Tommy G. Thompson today announced the release of $50 million to fund 94 new research grants, contracts and other projects to reduce medical errors and improve patient safety.  The initiative represents the federal government's largest single investment to address the estimated 44,000 to 98,000 patient deaths related to medical errors each year. The 94 projects now being funded will be carried out at state agencies, major universities, hospitals, outpatient clinics, nursing homes, physicians' offices, professional societies and other organizations across the country.

Accreditation

Ambulatory surgical centers (ASCs) have more than doubled in number between 1990 and 2000, yet Medicare's system of quality oversight for ASCs "is not up to the task," the DHHS Office of Inspector General (OIG) concluded in a recent inspection report. The report, "Quality Oversight of Ambulatory Surgical Centers" (OEI-01-00-00450), found that nearly a third of ASCs certified by state agencies had not been recertified in five years or more.  Other reports available include:  Quality Oversight of Ambulatory Surgical Centers: The Role of Certification and Accreditation" (OEI-01-00-00451) and "Quality Oversight of Ambulatory Surgical Centers: Holding State Agencies and Accreditors Accountable" (OEI-01-00-00452).

 See:    http://oig.hhs.gov/oei/oei.html

JCAHO

2-25-02:  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched an initiative to identify a set of outcomes-based measures for assessing the quality of hospital intensive care units (ICUs). The performance measures is expands the JCAHO's ORYX initiative, which seeks to integrate performance measures into the accreditation process. The use of standardized performance measures is intended to allow more meaningful comparisons of performance across hospitals nationally.

See:    http://www.jcaho.org/news_frm.html

Angioplasty vs. Surgery

Balloon Angiolplasty is just as effective as surgery, easier on patients and costs about half as much according to Dartmouth Medical School researcher reports presented at the Chicago meeting of the Radiological Society of North America.  This mirrors results of a recent Mayo Clinic heart study.  Surgery average cost is about %12,000 and the less invasive angioplasty and stent treatments average about $6,500. Source: Chicago Tribune (12-16-01): section 13, page 3.

Federal Court Lawsuit

America Airlines was sued in federal court in Los Angeles for allegedly paying for Viagra pills for its male employees but denying women employees health benefits to pay for birth control pills, pap smears or infertility treatment.  The lawsuit claims Martina Alexander was told in a 1999 letter from American that her health plan covers expenses "medically necessary to sustain life.  That is why pap smears, birth control pills and infertility treatment are not covered."  Source: Chicago Tribune (12-14-01): section 3, page 2.

Measuring Effectiveness of Appropriate Pain Management

AMA, JCAHO AND NCQA are teaming up to develop a common set of evidence-based measures for evaluating the appropriateness and effectiveness of pain management for patients suffering from cancer, back
pain and arthritis, per JCAHO News Releases - December 18, 2001.

Medical Guidelines

10/01:     A study of medical guidelines in the Sept. 26 Journal of the American Medical Associationby funded by the federal Agency for Healthcare Research and Quality (AHRQ) found that half of the guidelines were outdated in less than six years, concluding that guidelines need to be reviewed every three years.  AHRQ stopped developing guidelines in 1997.  The National Guideline Clearinghouse, is an online database of evidence-based guidelines sponsored by AHRQ in partnership with the AMA and American Assn. of Health Plans and has recommended practice guidelines by some physician groups and health organizations.  

For example of some revised guidelines:

American College of Physicians--American Society of Internal Medicine (ACP_ASIM) issues its guidelines in the Annals of Internal Medicine and contributes some to the online clearinghouse, said Vincenza Snow, MD, the group's senior medical associate for scientific policy.  In May 2000, ACP-ASIM began putting expiration dates on its guidelines.  Guidelines are reviewed annually to determine if they need updating or should be scrapped, said Dr. Snow, who oversees the college's guidelines and the recommendations should be reviewed regularly to incorporate new research and treatments.

Sentinel Event Alert:  Medication Errors Related to Potentially Dangerous Abbreviations, Issue 23
10/2/01:    According to the Joint Commission, one of the major causes of medication errors is the ongoing use of potentially dangerous abbreviations and dose expressions. Underlying factors contributing to many of these errors are illegible or confusing handwriting by clinicians and the failure of health care providers to communicate clearly with one another. Because medication safety and the identification, prevention and timely reporting of medication errors are of primary importance to the Joint Commission, this issue of Sentinel Event Alert specifically addresses medication errors related to the use of dangerous abbreviations and dose expressions used in prescribing medications.

See:    http://www.jcaho.org/edu_pub/sealert/sea23.html

12/19/01:    URAC Announces Nation's First Accredited Health Web Sites This program is to helps assure reliability of information and consumer privacy.  URAC has accredited thirteen health Web sites under this program, which measured them against standards for quality and accountability. URAC standards cover issues including health content editorial process, disclosure of financial relationships, linking to other Web sites, privacy and security, and mechanisms for consumer complaints.  This program includes 53 specific standards and detailed descriptions of what Web sites must do to achieve accreditation.

See:    http://websiteaccreditation.urac.org/

NCQA Reports 

9/01:    The National Committee for Quality Assurance's ("NCQA") fifth annual State of Managed Care Quality report released September 6, based on data submitted by 372 health plan products, covering over sixty-three million people reports overall Improvement in Managed Care Quality for Second Straight Year.  It indicates health plans' success in preventative care, such as finding that 74% of patients who had suffered a cardiovascular event received cholesterol screenings in 2000, compared to 69% in 1999. In addition, 48% of diabetics received annual retinal exams in 2000, up from 45% in 1999. As a result of the recent quality improvements, NCQA predicted employees would take eight million fewer sick days this year, resulting in an estimated $1.4 billion in productivity savings. 

NCQA, which accredits and certifies healthcare organizations and plans to release an economic model to help employers measure the financial benefits of providing employees with high quality healthcare.

11/01:    Standardized health plan performance measures such as Consumer Assessment of Health Plans ("CAHPS") and the Health Plan Employer Data and Information Set (HEDIS) are typically used by consumers, States, employers, and others to ealuate health plans.  The CAHPS survey was developed by the Agency for Healthcare Research and Quality to help lay the groundwork for informed healthcare choices and enhanced quality of care.  Researchers found that materials for consumers that break down cost, coverage, choice of providers, access to specialty care, out-of-pocket costs, premiums and help consumers prioritize what is most important to them in choosing a health plan is helpful for consumers.  

Evidence Based Process

6/29/01:  Centers for Medicare & Medicaid Services (CMS) will expand Medicare coverage to include a surgical treatment known as sacral nerve stimulation for urinary incontinence and other voiding difficulties.  The decision by CMS, formerly the Health Care Financing Administration, to expand coverage was made using Medicare's evidence-based coverage process. The scientific and clinical evidence reviewed by CMS regarding the clinical value of sacral nerve stimulation is sufficient to support coverage of this technology for Medicare beneficiaries nationwide.  "CMS' new coverage process is helping Medicare make the right decisions, based on scientific evidence, on when the program should cover new items, services and procedures," said Jeffrey Kang, M.D., director of CMS' Office of Clinical Standards and Quality.

HHS Press Releases

8/20/01:  "NEW SENTINEL SYSTEM WILL MONITOR U.S. BLOOD SUPPLY":  HHS Secretary Tommy G. Thompson today announced that a new "real time" monitoring network is being launched to measure the blood supply in key local areas, regions and nationwide. The new sentinel system will receive daily reports from 29 hospitals selected hospitals and will measure current demand and supply on hand, giving hospitals and blood suppliers a more useful picture of supplies and possible emerging problems.  This new system is being implemented at a cost of about $350,000 per year.

NIH Press Releases

8/17/01:  The National Institute of Allergy and Infectious Diseases
(NIAID) releases "Focus on Asthma," a Web site feature that explains how NIAID-sponsored researchers are looking for ways to better understand, prevent and treat asthma. Since 1980, asthma rates have increased 75 percent, and the death rate, though low, has doubled. Asthma is now one of the country's most common and costly diseases, says the Centers for Disease Control and Prevention (CDC), affecting an estimated 17 million Americans.  Researchers have known for some time about the connection between cockroach allergen and asthma, especially in inner- city children, but no one knows exactly how or why exposure to these insects leads to asthma.

See: http://www.niaid.nih.gov/spotlight/asthma01

8/23/01: "NIMH SCIENTISTS DISCOVER NEW DETAILS OF
HIV INFECTIOUS PROCESS".  National Institute Mental Health (NIMH) is one of 26 components that make up the National Institutes of Health, part of the U.S. Department of Health and Human Services.

5/18/01:The following inspection report has been posted to the
Office of Inspector General's Web site. 
Practitioner Data Bank: A Signal for Broader Concern
(OEI-01-99-00690)

"This inspection addresses the extent to which managed care organizations report adverse actions they take against health care practitioners to the National Practitioner Data Bank. We found that 84 percent of managed care organizations (1,176 out of 1,401) have never reported an adverse action to the Data Bank. Two likely explanations for the low level of reporting are a limited focus on clinical oversight of practitioners, due to heavy reliance on contracted panels of physicians rather than salaried physicians, marketplace emphasis on price, and consumer emphasis on access to physicians; and reliance on downstream entities--practitioners. We raise concerns about the capacity of these downstream entities to monitor substandard care, due to a number of limitations."
See:    http://www.hhs.gov/oig/oei/whatsnew.htmlManaged Care Organization Nonreporting to the National

The Office of Inspector General has posted a Federal
Register Notice about:   "Announces a User Fee Increase, Effective 10/1/01, for Authorized Entities to the Healthcare Integrity and Protection Data Bank."  

5/18/01 Pursuing Perfection in Healthcare Performance 
According to a survey by The Institute for Healthcare Improvement (IHI) 58% of providers and administrators think healthcare in this country is not very good, and 80% of those polled believe fundamental changes are needed to improve the American healthcare system. 

The Robert Wood Johnson Foundation and IHI announced a new $20.9 million initiative, "Pursuing Perfection: Raising the Bar for Healthcare Performance," intended to help hospitals and physician organizations dramatically improve patient outcomes by pursuing perfection in all of their major care processes. The working definition of pursuing perfection: deliver services accurately and correctly and at the right time; avoid services that are not helpful or cost-effective; prevent safety hazards and errors; and respect each patient's unique needs and preferences. The program provided grants to twelve institutions to design error-free healthcare processes. 
See:    http://www.ihi.org/pursuingperfection.

Programs and Point of Service Plans

The Academy has developed the "requirements" document as a statement of AAFP policy on family physician's interaction with managed care plans. Its intended use is to assist individual or groups of family physicians, constituent chapters and others in their efforts to work with managed care organizations to provide high quality, cost-effective health care to enrolled populations. The requirements are meant to build bridges and not to erect barriers between family physicians and MCOs.

By necessity, this is a "living document" to which additions and modifications are routinely made by the AAFP Board as the health care market evolves and creates new challenges and opportunities. Suggestions for managed care issues which require additional attention by the Academy should be directed to the attention of the Socioeconomics Division at the Academy's Kansas City headquarters.

Requirements Related to Managed Care Plans, Utilization Review Programs and Point of Service Plans

The following is from the American Association of Family Physicians website at http://www.aafp.org/managed/require.html:

1. Managed care plans should provide sufficient information about plan terms and conditions to allow prospective enrollees and patients to make informed enrollment decisions:
   
   
2. Physicians must be able to discuss any information, clinical or financial, necessary for their patients to make informed decisions regarding their medical care.
   
   
3. Managed care plans should demonstrate that they can provide sufficient access to physicians and other providers so that all covered medical services are provided in a timely fashion;
   
   
4. Managed care plans should develop contracting criteria for physicians. Such criteria should be available for review by physicians and should be utilized in determining physician selection, retention and disenrollment;
   
   
5. Managed care plans should have sufficient financial reserves to ensure proper and timely payment for covered services;
   
   
6. Managed care plans should establish a mechanism by which physicians enrolled with the plan can provide input into the plan's medical policies;
   
   
7. Managed care plans should periodically provide to each physician data to evaluate his or her performance relative to stated plan performance criteria and in relation to a comparable group of plan physicians which are age, sex and severity adjusted.
   
   
8. In regard to physician disenrollment, managed care plans must provide physicians with the reason for disenrollment, the right to appeal the disenrollment decision and sufficient notice of disenrollment to allow the orderly transfer of patient care responsibilities;
   
   
9. Medical directors of utilization review programs should make coverage decisions based on clinically sound guidelines, however, physicians should have the right to appeal adverse coverage decisions and have such decisions reviewed by another physician with the same expertise and of the same specialty;
   
   
10. Utilization review programs must respond to requests for prior authorization of a service within two business days;
    
    
11. Whenever practical, potential enrollees should have a choice of health plans at least one of which should include a point-of-service option;
    
    
12. Managed care plans may impose an additional, actuarially justified premium and higher patient cost-sharing requirement for "out-of-network" care;
    
    
13. Economic or capacity profiling of a physician must be adjusted to recognize case mix, severity of illness, age of patient and other features of a physician's practice that may account for higher than, or lower than, expected costs;
    
    
14. Managed care plans should not discriminate against individuals with expensive, long-term or chronic medical conditions by excluding such patients (i.e., pre-existing conditions);
    
    
15. Managed care plans should not discriminate against members of high risk, vulnerable, or other similar patient populations by excluding physicians with practices containing substantial numbers of such patients; and
    
    
16. Managed care plans should not utilize any criterion that excludes a physician based on sex, race, creed, national origin or any other factor prohibited by law.

    

5/18/01:  Ever think about costs of providing healthcare?  Consider a study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA):  The leading preventable cause of mental retardation is fetal alcohol syndrome (FAS).  FAS imposes lifetime economic costs estimated at $1.8 million per child in health care and indirect costs such as lost productivity. An estimated 3 to 30 infants per 10,000 live U.S. births and about 6 percent of the offspring of alcoholic mothers are diagnosable with FAS.  Scientists have long known that drinking leads to adverse health effects on the developing fetus.  When a woman drinks alcohol during pregnancy, her fetus is at risk of spontaneous abortion, FAS, and other birth defects.  Children with FAS exhibit brain damage, growth retardation, and a characteristic pattern of facial malformations, whereas those with less severe alcohol-related birth defects (ARBD) exhibit neurobehavioral deficits.  According to the NIAAA "Alcohol Alert" bulletin (Number 50, December 2000): The only responsible advice to women who wish to become pregnant and those who are pregnant is to avoid alcohol use entirely.

See text of article at: www.fasebj.org after 12:01 A.M. May 18, 2001

11/27/01:    The Joint Commission is launching a certification program for
disease-specific care (disease management) programs and services. The
objective of this voluntary program is to offer an independent,
comprehensive evaluation of organized programs of prevention and
management services to participants who have specific diseases or
conditions.

5-1-01: JCAHO's Board of Commissioners has identified five strategic priorities for 2001 -- improving the value of accreditation, patient safety, physician engagement in the accreditation process, information dissemination, and establishing evidence that standards and performance measurement improve the quality and safety of patient care.

5/23/01    JCAHO news:  The Joint Commission on Accreditation of Healthcare Organizations today announced that July 1,2002 is the date on which accredited hospitals will be expected to begin collecting data on the first sets of the ORYX® core performance measures.

April 27, 2001: Per JCAHO: AMA, JCAHO and NCQA Release Common Measures for Diabetes Care - Organizations Reaffirm Commitment To Coordinated Performance Measurement

The Food and Drug Administration ("FDA") recently issued guidance warning hospitals, nursing homes, and other healthcare facilities of the hazards of medical gas mix-ups. The FDA noted that reports from the past four years showed that at least seven deaths and fifteen injuries to patients resulted from mistakes in connecting the oxygen supply system to a different gas instead of medical grade oxygen. The errors were mainly attributed to insufficient training on how to connect the vessel to the oxygen system and human error in failing to read the label on the gas container. The guidance contained recommendations on how to avoid these errors.
See: http://www.fda.gov/cder/guidance/4341fnl.htm.

3/19/00:    An editorial in The New England Journal of Medicine (March 1, 2001), "Are Appropriateness Criteria Ready for Use in Clinical Practice?" by Paul G. Shekelle, M.D., Ph.D. reviews the article by Hemingway and colleagues entitled "Underuse of Coronary Revascularization Procedures in Patients Considered Appropriated Candidates for Revascularization" in this issue of The New England Journal of Medicine.  The researchers in this study found a strong, graded relation between outcomes and appropriateness score.  This editorial asks how a physician is to decide whether patients will be helped or harmed by particular procedures.  This editorial examines how the researchers developed a technique to determine the appropriateness or inappropriateness of a procedure for particular patients using a systematic review of the literature with the judgment of a multidisciplinary group of expert clinicians calculating an appropriateness score on a scale of 1 to 9 for a comprehensive set of clinical situations in which the procedure may be offered to patients.  Potential problems with the development and use of appropriateness criteria is the imprecision in the development of the criteria and the lack of evidence for their validity.  This editorial recommends for physicians to use appropriateness criteria as one factor among many to contribute to any decision in clinical practice, that the "quest for better criteria should not delay the application of existing criteria in clinical practice."

An article in The New England Journal of Medicine (March 15, 2001), "The Cost Effectiveness of Combination Antiretroviral Therapy for HIV Disease" by Kenneth A. Freedberg, et al concludes that the treatment of HIV infection with a combination of three antiretroviral drugs is a cost effective use of resources.  An editorial about this article claims that United States has a fragmented system of care for HIV-infected patients.

"Crossing the Quality Chasm: A New Health System for the 21st Century (March 1, 2001)"
On March 1, 2001 the Institute of Medicine of the National Academies issued a report indicating that reorganization and reform are urgently needed to fix what is now a disjointed and inefficient health care system.  The report requests for Congress to create an "innovation fund" of $1 billion for use during the next three to five years to help subsidize projects.  According to William C. Richardson, chair of the committee and president of the W.K. Kellogg Foundation, Battle Creek, Michigan, "For too many patients, the health care system is a maze and many do not receive the services from which they would likely benefit."

    The report suggests that clinicians, health care organizations, and purchasers - companies or groups that compensate health care providers for delivering services to patients - should focus on improving care for common, chronic conditions such as heart disease, diabetes, and asthma that are currently leading cases of illness in the United States and use substantial health care resources. 

    The committee's previous report, To Err Is Human: Building a Safer Health System, found that more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS.

    Use of Information technology, including voice mail between physicians and patients was emphasized.  This report recommends that the U.S. Department of Health and Human Services (HHS) should monitor and track quality improvements in six key areas: safety, effectiveness, responsiveness to patients, timeliness, efficiency, and equity. And the secretary of HHS should report annually to Congress and the president on progress made in those areas.

    Also, this report suggests public and private purchasers develop payment policies rewarding quality; that the federal government should identify, test, and evaluate various payment options that more closely align compensation methods with quality-improvement goals.

    The committee offers 10 new rules intended to make the health system more responsive to patients' needs and preferences and to encourage their participation in decision-making:       

"REPRINTED FROM CROSSING THE QUALITY CHASM:

NEW RULES TO REDESIGN AND IMPROVE CARE

Private and public purchasers, health care organizations, clinicians, and patients should work together to redesign health care processes in accordance with the following rules:

1. Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the Internet, by telephone, and by other means in addition to face-to-face visits.

2. Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.

3. The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision-making.

4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.

5. Evidence-based decision-making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.

6. Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.

7. The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system's performance on safety, evidence-based practice, and patient satisfaction.

8. Anticipation of needs. The health system should anticipate patient needs, rather than simply reacting to events.

9. Continuous decrease in waste. The health system should not waste resources or patient time.

10. Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care."

The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.

Information about this report can be found at:

http://www.iom.edu/IOM/IOMHome.nsf/Pages/Recently+Released+Reports

Department of Health and Human Services (HHS) Secretary Tommy Thompson announced on March 1, a nationwide preventive medicine campaign intended to promote healthy lifestyles to improve the quality of healthcare and quality of life for all Americans and reduce cost of healthcare.  According to the speech by Secretary Thompson, "so many of our health problems can be avoided through diet, exercise and making sure we taking care of ourselves."

Re:    URAC Accreditation:

On February 26, 2001, URAC (also known as the American Accreditation HealthCare Commission), a non-profit private organization that accredits managed care organizations, issued a draft set of Health Web Site Standards for public review and comment.  The quality-based standards will form the foundation of the first-ever third-party accreditation program for health Web sites.  Once implemented, this accreditation program will provide consumers and other stakeholders with a benchmark to evaluate the quality of health Web sites.

According to a press release on November 6, 2000 by URAC  has changed the the recredentialling standard to every three years; eliminated the requirement for primary verification of hospital privileges; and changed several facility credentialling requirements to "should" standards. These changes have the greatest impact on URAC's accreditation programs for HMOs and PPOs.  
To learn more about URAC or to read URAC's press release see their website at:  http://www.urac.org/

Re:    Nurses:

"140 Nurses's Aides Fired by U. of C. Hospitals," sub-caption "Registered Nurses Fear Work Burden," Chicago Tribune (October 31, 2000):  Section 1, pages 1 and 8.

    A cost cutting experiment to replace highly trained registered nurses with less costly, unlicensed assistants may be now changing as indicated by the firing of 140 nurses' aides by U. of C. hospitals.  Registered nurses are concerned about this approach as they fear that their duties will now increase to cover the services that the aides were providing.  The nurses are concerned that with increased workloads with fewer nurses to care for more and sicker patients will heighten the potential for deadly medical errors.

    Hospital officials claim that patient care will be maintained by improved efficiency and that enhanced training programs for temporary agency nurses will offset safety concerns.

    An average of 75% of today's patient care staff are registered nurses at Chicago hospitals as compared to a decade ago when nearly every hospital was "staffed exclusively by registered nurses.

    At two Chicago hospitals in the last year housekeeping staff wore nursing-style uniforms and were ordered to distribute medication on days when nursing staff was leanest.

    Up to one-third of all hospitals are operating at a loss.

According to Chicago Tribune, September 11, 2000, "Nursing Accidents Unleash Silent Killer":  In U.S. Hospitals since 1995, according to analysis of state and federal records, regarding infusion pumps used at hospitals and nurses error found:  39 patients were killed after nurses made errors, 373 patients injured, and 150,000 pumps in use in hospital with safety design flaws

According to Crain's Chicago Business, August 7, 2000:

    The Washington, D.C. based National Committee for Quality Assurance (NCQA) is now going to be accrediting PPOs, the most popular type of managed care plan in Chicago.  NCQA is publishing a list of PPO standards and by the end of this year expects to have accredited about 12 of the approximately 1000 PPOs in the U.S.

NCQA posts accreditation grades and HMOs' performance in areas such as access to care, service and doctors' qualifications on its Web site, www.ncqa.org for about 300 of the 600 HMOs in the U.S.

    To compare HMOs with PPOs, New York based Segal Co., through Segal Q-Val, sends a customized questionnaire to health plans being considered by employer groups and recommends plans that best meet companies needs.  Companies can explore health plan performance in any of 25 quality areas such as diagnostic lab services and enrollee satisfaction.  The cost would be about $10,000 to $15,000 for evaluating four or five health plans.

    The University of Chicago Hospitals advertises in this Crain's issue that it is ranked among the "Best of the Best" Again Again and Again.... The advertisement states:  Each year, U.S. News & World Report surveys America's 6,300 hospitals to identify the best in the country.  This year, only 15 hospitals made the "Honor Roll" - a special list of those meeting the toughest standards.  Once again, only one is right here in Chicago:  The University of Chicago Hospitals, ranked one of the fest for the fifth time.  No other hospital is Illinois has ever come close.  See:  www.uchospitals.edu.

From Modern Healthcare:

    The New York State Health Accountability Foundation, a partnership of public and private groups has issued its second annual report card on the state's 25 commercial HMOs.  It compares the HMOs with others in the sate and across the nation based on scores on 12 different performance measures such as physician turnover to the use of life-saving beta blockers after heart attack.  It found that New York's HMOs' performance varied.  New York's HMOs score on the percentage of heart attack patients in the HMOs receiving beta blockers was 74%, as compared to the 80% national average.  For copies of the report - See:  www.nyshaf.org

From Modern Healthcare:

    Five hospital groups, American Hospital Association, the Association of American Medical Colleges, the National Association of Public Hospitals and Health Systems, the Premier hospital alliance, and VHA, another hospital alliance, are demanding another delay in the implementation of the Medicare prospective payment system for outpatient care.  The American Association of Retired Persons said it will "strongly oppose" any further delay in the PPS because it would force Medicare beneficiaries to wait even longer before they see the decreases in their coinsurance payments promised under the PPS.

    The original start date was July 1, but HCFA pushed that back to Aug. 1.

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