Friday, April 30, 2010

Wellpoint Changes Policy on Recission

I wanted to stay away from this story but as it has evolved, I can't resist it anymore. First there were the very serious charges that Wellpoint specifically targeted women with breast cancer (who were also very costly for them to continue to insure) for thorough audits to look for excuses to cancel their policies. These charges got reinforced by healthcare heavyweights like HHS Secretary Kathleen Sebelius. Then there were the adamant denials by Wellpoint that the charges were completely unfounded. At that point I didn't know who to believe and felt it was best not to comment until more came out.

Now comes the announcement from Wellpoint that even though they did nothing wrong they are changing how they proceed on this going forward. So now I am confused. This sounds a lot like the little boy accused of taking cookies from the cookie jar who says, "No I didn't do it but I won't do it again". At least whatever practices were or weren't happening will now stop.

The practice of rescission by healthcare providers has gone on for years and has been the ugliest form of cost shifting that happens all over the place in the current payment patchwork that we have in place. Thank goodness payment reform is here. It is certainly needed. Addressing issues like rescission and denials for pre-existing conditions is long overdue. I'm not thrilled with all aspects of the new healthcare reform bill but I am certainly happy to see these issues addressed.

More on this later.

Mark Brodeur

Thursday, April 29, 2010

More Evidence That Hospitals Must Continue To Focus On Improving Value

The latest report from the Leapfrog Group which is a nonprofit organization that rates hospitals value and represents major purchasers of healthcare benefits (mostly large businesses), shows good news and bad news. The good news is that overall improvement is shown in many of the categories compared to last year. but we still have a long way to go. More discouraging is the fact that a wide disparity still exists between the high performing and low performing hospitals. Clearly the low performers need to take notice and devote significant time and effort to improve performance now, otherwise they will not be around for long.

Leapfrog has been around for 10 years and admitted in their latest statement that the improvements in hospital performance over this period has been well under what they expected, especially considering that we are the most expensive healthcare system in the world.

Some of the improvements noted are:

1) Pneumonia Treatment- 57% met the standard up from 34% last year

2) Heart Bypass Surgery- 53.5% met the standard up from 43% last year

3) Angioplasty- 44% met the standard up from 35% last year

4) Heart Attack- 33% met the standard up from 26% last year

Overall, even the newest numbers are less than impressive particularly when looking at the low performers. For heart bypass surgery, a 56% difference existed between the best and worst providers. For angioplasty there was a 79% difference. There is clearly a lot of waste in the low performers. One factor is the lack of compliance with nationally endorsed, evidence based guidelines which Leapfrog strongly endorses. Leapfrog asserts that more than 3,000 deaths could be avoided each year if these standards were implemented in all hospitals.

While Leapfrog is still a voluntary survey and only 1,244 hospitals across the country are participating, performance at their standards is a must for all hospitals. If not Leapfrog, then some other survey will be used in the near future to provide the public with performance measures of every hospital.

For those hospitals at the lower end, get busy now cleaning up your act. We at Compirion would be happy to assist you.

More on this later.

Mark Brodeur

Wednesday, April 28, 2010

Debate Over Benefits of Healthcare Reform Continues At AHA Meeting

The American Hospital Association's Annual Meeting, which is one of the most prominent gatherings of healthcare leaders in the country, was recently held in Washington, D. C. It was an opportunity for politicians and members of the Obama administration to address healthcare movers and shakers about their take on the new reform bill. It promised to provide strongly differing opinions and did not disappoint.

First up was HHS Secretary Kathleen Sebelius who emphasized that we need to focus on value over volume like we have in the past. To achieve this we need to provide real patient centered care. She stated that a government oversight role is key to getting this done, and compared it to umpiring a baseball game. This is probably a good comparison because most healthcare providers like government oversight about as much as a batter likes being called out on strikes from an outside pitch.

To no one's surprise, House Speaker Nancy Pelosi echoed support for the new legislation. She stated that this is a giant leap forward in access and affordability in healthcare. "People can be more entrepreneurial" she said. "They can take risks. It's about a healthier economy." I'm not sure who's economy she is talking about, but the one in this country is far from healthy, and I'm not sure how this legislation will fix that. As I have stated in previous posts, it looks like the increased access of the new legislation will add more costs than the savings that are projected.

From point to counter-point, Senator John Cornyn, a Republican from Texas, did at least agree that we need to focus on value and not volume. But that is were the agreement with the Obama plan ended. He feels strongly that the new legislation will make our economy worse, do little for accessibility and nothing for tort reform. I certainly agree with him on the last point. I have frequently commented on the cost of defensive medicine that is fueled by the pervasive threat of frivolous lawsuits. This plan does nothing to address these needless costs. This is why a real bipartisan approach to this issue would have been nice.

So the debate continues as we enter this new era of providing healthcare. Certainly change from the previous course was needed. Are we heading back in the right direction or further off course? It all depends on who you ask.

More on this later.

Mark Brodeur

Tuesday, April 27, 2010

Three Key Factors In The Physician- Patient Relationship

Perhaps this is better titled "Patient-Physician" relationship. The old days of Marcus Welby as doctor knows best are gone. Today's physicians need to deal with a much more patient centered culture. There are a number of factors that affect this new dynamic but three are emerging as key to the maintaining a strong relationship between physicians and their patients.

1) Knowing your patient and being in sync with them builds more compliance. Generally patients are taking over more control of the relationship they have with their doctor, but not all of them. It is important for the physician to know how active a role the patient wants to play and coordinate his or her communication at that level. A study published in the May issue of the Journal of General Internal Medicine looked at patient prescription refill records. The study found that patients that are of the same mindset as their physician regarding the balance of control were more likely to take their prescribed meds. Patients with high personal control beliefs about their health were 50 percent less likely to adhere to their medicine regimen if their physicians didn't share their belief in patient control.

2) Practicing defensive medicine damages the physician-patient relationship. Physicians often feel compelled to order tests that have a low probability of being helpful simply out of fear of missing something and being sued later. Patients with high personal control beliefs about their health enter into this as well. OBs may do a C-section that is not totally indicated simply because the patient demands it. A survey of physicians by Jackson Healthcare reported that two thirds of them feel this is harming the physician-patient relationship. Seventy-two percent think this negatively affects patient care. And one fourth of Cardiologists admit to ordering unnecessary tests strictly out of fear of being sued. Clearly this environment is destroying the trust that used to exist between physicians and patients.

3) The emergence of the medical home model will totally change physician-patient relationships. This model is being highly touted under healthcare reform as a cost effective way to expand coverage to the many who were previously uninsured. Under this model the role of the primary care physician will be expanded to cover care that was previously done by specialists and much of what was done by the primary care physician will now be done by physician extenders. This will severely restrict the role of specialists unless they sign on to play more of a primary care role in the medical home. The primary care physician will now have more responsibility for more patients while spending less time with them. His role will be supplemented by physician extenders who will form their own relationship with patients.

All of the factors are forever changing the dynamic of that most basic unit of healthcare, the physician-patient relationship. Have we really made progress or were we better off with Marcus Welby making house calls with his little black bag?

More on this later.

Mark Brodeur

Monday, April 26, 2010

Early Reports Indicate No Cost Savings From Healthcare Reform

The first report from the supposedly neutral experts at the Health and Human Services Department has good news and bad for President Obama's newly enacted healthcare reform bill. The good news is that 34 million uninsured Americans are expected to now have coverage under the new plan. The bad news is that they predict that spending will actually increase between 2010 and 2019 by $311 billion. This is after accounting for the Medicare cuts and new taxes on high cost insurance. Apparently the costs of insurance expansion have been underestimated. Who in the room is surprised at this development?

Republicans are quick to say "I told you so" while Democrats are touting the increased insurance coverage as a major victory. Apparently cost overruns is a glitch that can be fixed as we go. This may be true, but we need to find other ways of efficiency besides just decreasing payments to providers. Remember that the real driver behind healthcare reform is economic not political. The current system can not continue to fund itself without substantial overhaul.

In addition to the HHS report, a new poll by American Medical News which surveyed 172 hospital and medical group executives, found that most of them feel the new bill will have a negative impact on their facilities. Only 22% were pleased with the passing of the bill last month. Any new revenue from the coverage of previously uninsured patients will be more than offset by cuts in reimbursement primarily from Medicare patients. Also the increase in demand caused by the newly insured will further strain physician shortages in many areas, thus driving up the cost to provide these services.

A related concern is that this new climate will spell the demise of the independent physician practice. The economic demands will force all physician providers to be either salaried by the hospitals and health systems or part of a large multispecialty group. This will change the way medicine is practiced and ultimately impact the availability of providers.

These are just the early reports on the impact of healthcare reform. There will certainly be...

more on this later.

Mark Brodeur

Friday, April 23, 2010

Public Ranking Of Healthcare Providers Is Good, As Long As We Get It Right (Part 2)

Yesterday I discussed a popular hospital public rating list that may or may not be a little misleading. But physician providers are also increasingly subject to this type of rating. Commercial health insurance providers are the main groups putting together these ratings. Some are using this information internally to influence physician behavior or weed out costly providers. Others are going public with the information to help their clients pick the top providers. Again this is helpful as long as the information is truly accurate. In some cases it apparently is not.

A new physician rating group that was co-developed by Blue Shield of California and the Pacific Business Group on Health has come under fire by the California Medical Association even before it releases its first report. The CMA claims the new report has gross inaccuracies and disturbing flaws. Meanwhile the group generating the report, the California Physician Performance Initiative, says that the report is based on data for up to eight quality measures on 13,000 high volume doctors in the state. The CMA charges that much of the data is irrelevant but more importantly, the study does not take into consideration the patient's role for being compliant with the physician's directives. This is another whole dynamic that I will discuss more next week.

This brings me to the last point on this issue. Even the reporting of clearly accurate and objective data can be misleading. Let's consider the reporting of hospital mortality rates. To many this seems like an obvious way to judge a hospital's quality of care. The higher the rate the poorer the hospital. This is great except that it is totally false. Many hospital deaths are expected an unpreventable no matter how stellar the quality of care. In some cases the hospital's role is to provide palliative services and ease any suffering during a patient's final hours. A hospital with a strong reputation that takes care of a high percentage of critically ill patients is naturally going to have a higher mortality rate. What is needed is a list of totally preventable deaths. Wouldn't the plaintiff's attorneys love to get a hold of that list?

The concept of public rating of hospitals and physicians is a good one. It not only helps the public to make informed decisions, but keeps hospitals and physicians on notice of their need to provide high quality but cost effective services. But this only works if the information used for the rating is accurate, relevant and interpreted correctly.

More on this later.

Mark Brodeur

Thursday, April 22, 2010

Public Ranking Of Healthcare Providers Is Good, As Long As We Get It Right (Part 1)

In this era of consumerism I am all for the public having access to quality, safety, satisfaction and cost information about their hospital and physician. But along with that comes an obligation to get the information right. Not just reporting accurate data but also interpreting it correctly. Certain organizations have emerged as experts at rating hospitals and people tend to believe what they say. Is the hospital Joint Commission or HFAP accredited? How many stars does give each of its major services? Are they on the Thomson Reuters Top 100 Hospital List? How does it rank under Medicare for its Core Measures of Quality and HCAHPS scores for patient satisfaction? What is it's Press Ganey percentile ranking?

The organizations I have just mentioned use very objective criteria to assess hospital performance. It could be argued that they don't necessarily look at the factors that are the most important, but at least their conclusions are based on data and objectively compare one hospital with another. But these aren't the only measures out there.

Many consumers look with great interest at the highly touted "Best Hospitals" list published every year by U S News & World Reports. A recent study in the Annals of Internal Medicine has found that this list is determined by subjective reputation enjoyed from specialist physicians and not from any objective measures of quality and safety. To generate the list, the magazine asks specialists around the country to list the top five hospitals in their field that they would use for patients with very serious issues. This isn't necessarily a bad indicator, but the follow up study in Annals showed inconsistent correlation between objective measures of quality and the top 50 hospitals listed by U S News. It also doesn't consider that these hospitals may be the best for very serious and complex conditions, but may not provide the best care for far less serious issues that still require hospitalization.

More on this tomorrow.

Mark Brodeur

Wednesday, April 21, 2010

Three Principles For Improving the Value of Your Hospital

A recent article in Healthcare Executive discussed how top performing systems are addressing the new "Quality-Cost Imperative". I prefer to call it becoming a high value provider. As I read about what they are doing successfully, three themes stood out to me. These are also the themes that we at Compirion see at client hospitals.

1) Narrow the set of goals you address and stay focused on them. Two mistakes we see hospitals make are; first, trying to fix everything at once and second, shining a spotlight on a problem for a brief period and then forgetting about it. If you try to accomplish too much at once you end up accomplishing nothing. It is important to have a comprehensive list of the issues to address, but rather than deal with all of them, you need to prioritize. Let the staff focus in just a couple of areas. But just as important you need to stay focused for an extended period. Even with our rapid cycle techniques and full time staff involvement, we find it takes at least six months of attention to change culture and achieve sustainable improvement.

2) Link financial health to clinical outcomes. There are two myths in healthcare that need to be eradicated. First is that improving quality always costs money and doesn't save it. Second is that you can run a financially successful hospital without addressing quality. Many quality initiatives can save money in the short run. They all provide financial return in the long run. Look at the list of Top 100 Hospitals and see how many have poor or even mediocre quality measures; none.

3) Focus on best practices rather than worry about the causes of variability. After many hospitals identify areas that are not performing consistently, they get bogged down and frustrated trying to figure out all of the causes of this inconsistency. Take this time and effort and apply it to creating best practices in these areas and don't worry about why the old system didn't work.

To get more specifics on applying these principles at your hospital I invite you attend my free webinar on "Preparing Your Hospital for the Impact of Healthcare Reform". You can find the schedule of presentations and register at our website:

More on this later.

Mark Brodeur

Tuesday, April 20, 2010

Proposed 2011 Medicare Rates For Hospitals Aren't Rosey

It should come as a surprise to no one that Medicare is reducing its rates for hospital services in 2011 for acute and long-term hospital stays under the Prospective Payment System. This action is independent of and does not include any payment changes as part of the new healthcare reform bill. So there will certainly be more payment reductions ahead.

Actually the new rates proposed for Fiscal Year 2011 (which starts October 1, 2010) are a matter of give and take. For acute care hospitals, a 2.4% inflation increase will be added. But then a -2.9% adjustment will be applied. This negative adjustment was mandated after Medicare experienced unexpected payment increases to hospitals in 2008 from changes in coding practices. Now they are trying to get their money back. It seems that the intensity of services provided Medicare patient in 2008 rose dramatically, at least according to the final diagnoses that were coded. Medicare claims that hospitals were gaming the system. Hospitals claim that they just got smarter to get paid what they deserved. Either way, Medicare is now penalizing hospitals to get back money it did not budget for 2008 and 2009.

Long-term hospitals will also feel a pinch in 2011. They will get the 2.4% inflation increase but then get hit with a -2.5% adjustment for the same coding issue. The proposed rate changes will apply to 3,500 acute hospitals and 420 long-term hospitals. The changes are expected to save $142 million and $41 million respectively.

Hospitals with a high rate of Medicare patients should look at this as just the beginning. As for the rest of your patient mix, other insurers will be following suit. The days of cost shifting to private insurers are over. The only thing left to do is become the most efficient provider on the block.

More on this later.

Mark Brodeur

Monday, April 19, 2010

High Cost Hospitals Being Excluded From Some Insurance Plans

What once seemed unthinkable is now gaining traction as a way for health insurance plans to deal with rapidly rising healthcare costs. That is, excluding certain high cost hospitals from participating in plans. This is particularly strong in markets where there are competing hospitals providing the same scope of services. And it even extends to hospitals that have garnered an excellent reputation over the years like Massachusetts General and Brigham and Women's hospitals.

According to the Boston Globe, Massachusetts is offering a restricted network plan to its 300,000 state employees promising a 20% discount to them if they give up access to some of Boston's most renowned hospitals. This type of arrangement has not been considered in the past. The prestigious institutions have had the clout to steer patients and opt out as providers to companies that tried to create restricted networks. That clout is now waining in the face of soaring healthcare costs. If these restricted networks are successful, there will soon be cost shifting to the open networks pricing them out of the market.

What does this mean for other hospitals? Clearly the higher cost and lower value providers are in jeopardy going forward even if they enjoy an excellent reputation. Now is the time for all hospitals to ensure their status as a high value provider. This includes maximizing quality and customer service ratings while lowering costs. Even though this recent development is addressing only costs, insurance providers are also closely monitoring quality and service metrics dropping those hospitals that do not measure up.

If you are currently a high value provider, this could be seen as good news for you. Some of your competition may be forced out of new networks being formed in the future. If you are still struggling with quality, service and cost effectiveness issues, now is the time to act. Obviously, we at Compirion Healthcare Solutions would be happy to assist you with this. It is what we do and we have a great track record of success.

It looks like we are back to Darwinism and survival of the fittest.

More on this later.

Mark Brodeur

Friday, April 16, 2010

Another Financial Argument For Patient Safety

After writing yesterday's blog on Patient Safety, I came across another study, this time from the RAND Corporation, that provides more ammunition to use on those skeptics who are still not convinced that patient safety is a good financial investment. There have been numerous studies showing the direct cost savings of avoiding adverse events thus lowering length of stay and utilizing fewer resources. This is the first study I have seen that directly correlates lowering your number of adverse events with a lower volume of malpractice claims.

The study was conducted across numerous California counties between 2001 and 2005. It looked at both the number of adverse events and the volume of malpractice claims. The study showed a direct correlation of 3.7 fewer malpractice claims for every reduction of 10 adverse events. The good news is that this correlation held up from county to county. The bad news is that there is significant variation by county in the number of malpractice claims filed.

This has been my experience as well. Sometimes the likelihood of being sued is not just tied to how focused you are on patient safety, but also where you are located. Certain counties have national reputations as plaintiff attorney paradise. Even more reason for these hospitals to invest in patient safety. Tort reform in these areas would help also.

Another example of "Qualty first, Finances follow"

More on this later.

Mark Brodeur

Thursday, April 15, 2010

New Report Shows Little Progress in Key Areas of Patient Safety

We all know the eliminating healthcare associated infections (HAI's) not only reduces healthcare costs, but more importantly it provides much better care to our patients. With such a win-win potential why are we not making more progress in this area? But that is the case according to the 2009 National Healthcare Quality Report and National Healthcare Disparities Report issued by the U S Department of Health and Human Service's Agency for Healthcare Research and Quality.

Of the five types of HAI's in adult patients that were tracked, three showed increases, one remained unchanged and only one showed any improvement. Postoperative sepsis increased by 8%; postop catheter associated UTI's increased by 3.6%; infections due to medical care increased by 1.6%; blood stream infections from central lines showed no change; and postop pneumonia improved by 12%.

These rates can certainly be reduced but it will take a focused and sustained effort on the part of each hospital. Some hospitals are already addressing this issue. Over 100 participating intensive care units in Michigan have been able to keep their central line associated blood stream infections at or near zero by strictly adopting standardized procedures. Our experience at Compirion confirms that by putting the proper focus on this issue, which includes full support by the Board and CEO down to every housekeeper, you can make a dramatic and sustained difference.

It is frustrating to see reports like this emerge today, particularly with the overwhelming evidence that we need to stop the out of control spending increases. These HAI's can be prevented. I know, because at Compirion we have helped hospitals vastly improve their performance in this area. Providing the best care for patients should be enough motivation but being the most efficient provider you can be is essential for every hospital's survival in the future.

More on this later.

Mark Brodeur

Tuesday, April 13, 2010

Three Key Areas That Will Lower Healthcare Costs

Healthcare reform is here; at least payment reform is here. Only time will tell if we are effectively dealing with the real issues. The new bill played out in a grand theater of politics, but the issue driving it was, and still is, economic. We can't continue to afford the system we have in place. Healthcare costs are growing at too fast a rate to sustain in the future. Our system is totally focused on fixing people who are broken and not effectively dealing with promoting better health in the first place. If we are to succeed in changing our healthcare delivery system and ensuring its economic viability for the future, I see three areas that must be addressed, and soon.

1) Create Value- Lowering costs is only part of the equation. We must provide effective and efficient care. I know I am repeating myself but this is what "quality first and finances follows" means. The best way to create value is to do a better job in the first place. By eliminating medical errors we are improving patient outcomes while we are saving money. We can't make care totally error free but we can make it harm free. We need to focus on any unexplained clinical variation and eliminate it. We need to create a country of all Top 100 hospitals.

2) Coordinate Care- Currently our system is disjointed with various type of care providers really not talking with each other. With Electronic Medical Records becoming more commonplace, this will improve. But currently we have many gaps in our system between healthcare providers that leads to duplicate testing and dropped follow up. Patients with strong primary care providers can do well, but those that rely on hospital EDs or multiple providers for their primary care just go from one medical crisis to another.

3) Promote Prevention and Wellness- We are the number one country in the world for taking care of critically ill patients but we do not fare so well in overall health status of our nation. That is because we focus all of our resources on taking care of the sick and not enough on prevention and wellness. Sure we have flu vaccines and we wiped out polio long ago, but what about healthy lifestyles. Obesity and diabetes are our new epidemics. Money allocated to these areas will certainly not have an immediate return on investment, but the investment is still necessary to turn the current tide and save on future hospitalizations.

Hopefully we are in a new era that will begin with healthcare payment reform and evolve into really addressing the underlying issues that are driving our current system broke.

More on this later.

Mark Brodeur

Monday, April 12, 2010

Eight Characteristics of Today's Successful Leaders

No one would argue that these are challenging times for healthcare leaders. They were challenging even before the new reform bill was thrust upon us. It takes a special leader to guide an organization through the obstacle course that lies ahead. In a recent article in Frontiers of Health Services Management Debra Sukin lays out eight characteristics that leaders need today. I think she does a great job of hitting all of the key points.

1) Passion- This is something that you can't fake. You either have it or you don't. I have always found it easy to feel the passion for what I do in the healthcare field. Along with the frustrations and battles comes a great sense of accomplishment. We are doing important work. Today's leader needs this as inspiration to sustain him or her through the increasing challenges that lie ahead

2) Vision- While passion gives you the drive to keep going, vision gives you the direction. Obviously both are equally essential. Today more than ever, many constituents of your hospital are looking to the top leadership for a clear game plan. Not only must you show them where the organization is going but also make them a key part of getting there.

3) Quality Outcomes- My tag line is "Quality First and Finances Follow" for good reason. Today's market is putting a priority on best value, not lowest cost. You need to start with great service and then provide it efficiently. These two actually go hand in hand.

4) Industry Knowledge- Every great leader goes through a learning curve on the job and in the trenches. There is no substitute for experience. Leaders may be born with natural ability but they hone their skills through years of using them and learning the industry.

5) Critical Thinking- Today's leaders are bombarded with data, probably too much. The critical thinker knows which data is important and how to use it to make informed but decisive action plans. The proper course of action is not always black and white. Sometimes sound judgement is involved to make the best of competing choices.

6) Perspective- I have seen leaders get caught up in the importance of their position and forget what is really important and who makes the healthcare system work. As key as the leader may be, he or she is only one of the many making it happen.

7) Adaptability- There are no cookie cutter solutions because each organization is unique and the field is changing constantly at a fast pace. We have learned this well at Compirion Helathcare Solutions. We enter each hospital and first learn about its particular issues and frequently modify our plan as we go.

8) Continual Learning- Life is a lesson. If you have gone a day without learning anything new, it is a wasted day. In addition to the on the job learning that occurs, it is just as important to keep up with all the industry trends and developments. Every great leader sets aside time for continuing education.

To all the engaged leaders out there I thank you for what you do and encourage you to press on even harder during these challenging times. Your work has never been more important.

Mark Brodeur

Friday, April 9, 2010

Nine Factors Leading to Dramatically Reduced Mortality Rate

Bay Medical Center in Panama City, Florida, a client of Compirion Healthcare Solutions, has experienced a drop in their overall mortality rate by over 38% in just over two years. They went from 3.4 to 2.1 simply by focusing on the basics that when combined, can have a major impact on the quality of care. Their mortality rate for heart attack patients went from 15.7% to 15.1%, well below the national average of 16.1%. For heart failure the rate dropped from 9% to 7.4%, also below the national rate of 11.1%. And for pneumonia the rate remained steady at 8.5% which was already below the national rate of 11.4%. The process all started with something as basic as washing your hands. The nine areas of focus include:

1) Handwashing- A study revealed that only 25% of the staff washed their hands regularly between patients. Like most hospitals, the job of monitoring this fell to Infection Control. With Compirion's help this became the responsibility of the new Steering Team. Even the CEO was involved. With this level of scrutiny, compliance increased by 293% and remains at a level of 88-93%.

2) Blood Cultures prior to Antibiotics- Using a similar approach, compliance increased from 83% to 96%.

3) Pneumonia Vaccine- Compliance increased from 84% to 100%, which most hospitals would recognize as an amazing accomplishment.

4) Flu Vaccine- Compliance increased from 58% to 91%.

5) Reduced Throughput for ICU-bound ED Patients- Studies show that the mortality rate for patients waiting in the ED for more than 6 hours increases by 27%, so staying below this became a priority.

6) 24 Hour Chart Checks Missing- They found that 30-50% of the 24 hour chart checks were missed which led to longer length of stay.

7) Transcribed Physician Orders Missing- The numbers here were similar to the chart checks and had the same effect of lengthening stay.

8) Rapid Transport of Chest Pain Patinets To the Cath Lab- The connection here to lower mortality rate is obvious, but simplifying the complicated process that most hospitals have in place for this is an involved process. But through diligence, Bay Medical Center was able to streamline this process and save lives.

9) Rounding By All Levels of Hospital Staff- The last area is as basic as the first. Few people would associate this with an impact on mortality rates, but it works dramatically to change the culture and show real support for the staff who make the difference at your hospital.

Simply by focusing on the basics you can make a significant impact on the quality and safety of your hospital over time.

More on thei later.

Mark Brodeur

Thursday, April 8, 2010

Timely CT and MRI Scans Lower Hospital Costs

An interesting study was just published in the Journal of the American College of Radiology. It shows that CT and MRI scans can shorten a hospital length of stay and decrease overall costs if done early enough. This could be significant since inpatient costs represent 18% of total health care insurance premiums paid, and these costs are increasing by 8% each year.

The study was conducted at Massachusetts General Hospital and included over 10,000 hospital admissions all of which had at least one advanced imaging exam. Results showed that the length of stay was significantly shorter for those patients imaged on the day before or day of admission versus those imaged on day 2 or 3 for admissions of at least 3 days.

For admissions involving abdominal CTs the length of stay was 8.4 vs. 9.7 days. For neurologic MRI exams it was 7.6 vs. 8.7 days. This translates into a savings of $2,129 per admission by reducing hospital costs. This is extremely encouraging but must also be put in the proper context. This assumes that all of the CTs and MRIs are needed in the first place.

Our experience at Compirion has shown us that a number of hospitals have issues with unnecessary testing, particularly MRIs. At one hospital after we helped them redesign how these tests were ordered, they reduced inpatient MRI utilization by 93%. This too represents a significant savings.

So the trick here is to get physicians to only order advanced imaging exams that are necessary for the particular diagnosis causing the hospitalization and to order it on or before admission day. That is asking a lot of them.

More on this later.

Mark Brodeur

Wednesday, April 7, 2010

High Risk Health Insurance Pools Are Coming

One of the major objectives of the Obama healthcare plan was providing coverage for the millions of Americans with pre-existing conditions who have been shut out of appropriate healthcare coverage. The bill that was passed will address these issues over time with health insurance reform. But in the meantime insurance pools were to be set up to provide more immediate relief for these people. Well it looks like that relief is actually coming.

Five billion dollars has been allocated in the new plan to insure individuals with pre-existing conditions before the private insurance companies must accept them by 2014. The state governments have the option of running these pools directly or contracting out to a not for profit agency to do it. The new law calls for these pools to be set up within 90 days, so the clock is ticking. HHS Secretary Kathleen Sebelius is asking states to report back by the end of the month how they want to proceed.

Interestingly enough, over 30 states already have similar pools in place that cover over 200,000 individuals. Not surprising though is that every one of these pools operates at a loss. The concern is the size of the loss. In 2008 these pools paid a total of almost $2 billion in claims. The question is how far will our $5 billion go and how will this stay funded until 2014? Also will this cause a shakeout of insurance companies by 2014.? I suppose the administration is just counting on them to donate the huge profits they have been making to this goodwill effort. I'm not holding my breath.

More on this later.

Mark Brodeur

Tuesday, April 6, 2010

One ED's High Tech Approach to Manage Wait Times

I read with interest about a hospital (which shall remain nameless) using text messaging technology to keep potential patients abreast of current wait times in their Emergency Department. This is the next step past the many hospitals that already post ED wait times on their website. This strikes me as the wrong use of resources for two reasons.

First, by posting the wait times, aren't you really trying to discourage the people who don't need to be there in the first place from coming when its busy? It is the job of triage to be the gatekeeper for appropriate patients. But on the other hand, by texting that you have no wait, are you inviting inappropriate patients to come just so your staff will have something to do? If you truly need to use an ED, it shouldn't depend on the wait. And if you really only need some primary care, you should see your doctor or an urgent care center whether your local ED is busy or not.

Second, a financial investment in improved throughput for your ED makes more sense than investing in technology to tell everyone how long your waits are. If your waits are short you don't need to warn people. But if they are long do you really want the world to know? Wouldn't it be much better to get a reputation of having consistently short waits?

Coincidentally, Compirion did an ED project at a hospital not far from the one texting wait times. I am sure they are competitors. The hospital we worked at is now boasting about a number of quality improvements from quicker ED throughput to a dramatically low mortality rate. In my mind, knowing the ED wait time is a nice feature but I will take my chances with the hospital that has the high quality and service reputation.

More on this later.

Mark Brodeur

Monday, April 5, 2010

Eight Prevention Initiatives Addressed in the new Healthcare Reform Bill

Now that the dust is settling on the new healthcare reform bill and the major provisions it contains have had commentary from every side, its time to look a little deeper. One area President Obama talked about early on was prevention. I for one was not holding my breath expecting major dollars to be put into this area. But it appears that under the radar a number of wide ranging public initiatives to prevent disease and encourage healthy behavior have been passed. Efforts to combat our sedentary lifestyle, smoking and love of fatty foods are included:

1) More authority given to the FDA to regulate tobacco products
2) Chain restaurants to list nutritional information on their menus
3) Employers must provide reasonable break time for nursing mothers
4) Health insurance companies will soon have to cover all recommended screenings, preventive care and vaccines, without charging copays and deductibles
5) Medicare beneficiaries will get free annual physicals
6) Medicaid will cover drugs and counseling to help pregnant women stop smoking
7) A Federal fund will pay for more bike paths, playgrounds, sidewalks and and hiking trails
8) Employers can offer higher incentives to encourage healthier lifestyles for employees

These initiatives will not have a big impact on saving healthcare costs, particularly at first. Doing a Return on Investment analysis would be discouraging. But they will start to take us in the direction that we need to go. As Senator Tom Harkin, Chairman of the Senate Health Committee said, "We don't have a health care system in America. We have a sick care system. If you get sick you get care. But precious little is spent to keep people healthy in the first place." I couldn't agree more. It will be expensive to turn this around, but it is one of the major things we must do to reverse the trend of out of control spending increases in our healthcare system.

More on this later.

Mark Brodeur

Friday, April 2, 2010

Six Key Things You Need To Know About Patient Safety

According to HealthGrades annual study, patient safety is still a serious concern for our nation's hospitals. But clearly some hospitals are making progress and are statistically safer than others. Here are their six key findings:

1) Large safety gaps exist between top and bottom performing hospitals
Patients at top performers were 43% less likely to experience a medical error.

2) Patient safety events are common at US hospitals
Almost 1 million events occurred among Medicare patients in the last 3 years studied representing 2.3% of Medicare admissions.

3) Common patient safety events are very costly
During those 3 years over $8.9 billion was spent on excess costs related to these events.

4) Less improvement seen among the most common events
While some patient safety indicators improved in 2008 compared to 2006, the most common ones and the most serious ones got worse. Those that got worse included bed sores, collapsed lung, post-operative hip fracture, post-operative physiologic and metabolic derangement, post-operative pulmonary embolism or deep vein thrombosis, post-operative sepsis, and transfusion reaction.

5) Approximately one in ten Medicare patients with safety related events died
In the 3 years studied (2006-2008) 99,180 deaths occurred in our hospitals among patients who experienced one or more of the 15 patient safety events.

6) Most common patient safety incidents
The top four and their incidence rate (per 1,000 patients) are: failure to rescue (92.71), decubitus ulcer (36.05), post-operative respiratory failure (17.52) and post-operative sepsis (16.53).

This is one of the most significant areas that hospital leaders deal with. I made this a major focus area as a hospital CEO and we at Compirion Healthcare Solutions also have helped a number of hospitals significantly improve their performance on these metrics. I can tell you having addressed this from both perspectives, that it takes an intense effort to change culture and make patient safety a top priority for every employee. If you have concerns and would like any consultation please feel free to contact us at compirion. com.

More on this later.

Mark Brodeur

A copy of the full report including a list of the 15 indicators studied can be found at
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