Hospital Value-Based Purchasing: Measure Explanations

From Healthcare.gov:

Measure Title	Brief Explanation
Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival	Blood clots can cause heart attacks. Doctors may give this medicine, or perform a procedure to open the blockage, and in some cases, may do both.
Percent of Heart Attack Patients Given PCI Within 90 Minutes Of Arrival	The procedures called Percutaneous Coronary Interventions (PCI) are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both.
Percent of Heart Failure Patients Given Discharge Instructions	The staff at the hospital should provide you with information to help you manage your heart failure symptoms when you are discharged.
Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics	A blood culture tells what kind of medicine will work best to treat your pneumonia.
Initial Antibiotic Selection for CAP in Immunocompetent Patient	Antibiotics are medicines that treat infection, and each one is different. Hospitals should choose the antibiotics that best treat the infection type for each pneumonia patient.
Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision	Getting an antibiotic within one hour before surgery reduces the risk of wound infections. This measure shows how often hospital staff make sure surgery patients get antibiotics at the right time.
Prophylactic Antibiotic Selection for Surgical Patients	Some antibiotics work better than others to prevent wound infections for certain types of surgery. This measure shows how often hospital staff make sure patients get the right kind of preventive antibiotic medication for their surgery.
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time	Taking preventive antibiotics for more than 24 hours after routine surgery is usually not necessary. This measure shows how often hospitals stopped giving antibiotics to surgery patients when they were no longer needed to prevent surgical infection.
Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose	All heart surgery patients get their blood sugar checked after surgery. Any patient who has high blood sugar after heart surgery has a greater chance of getting an infection. This measure tells how often the blood sugar of heart surgery patients was kept under good control in the days right after their surgery.
Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period	Many people who have heart problems or are at risk for heart problems take drugs called beta blockers to reduce the risk of future heart problems. This measure shows whether surgery patients who were already taking beta blockers before coming to the hospital were given beta blockers during the time period just before and after their surgery.
Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered	Certain types of surgery can increase patients’ risk of having blood clots after surgery. For these types of surgery, this measure tells how often treatment to help prevent blood clots was ordered by the doctor.
Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery	This measure tells how often patients having certain types of surgery received treatment to prevent blood clots in the period from 24 hours before surgery to 24 hours after surgery.
Patient Experience of Care	A random sample of patients discharged from hospitals across the country are surveyed and asked questions about their feelings and perceptions about their hospital stay. This measure combines hospital performance on questions that asked patients their levels of satisfaction with some of the following elements of their stay: How well nurses communicated with patients How well doctors communicated with patients How responsive hospital staff were to patients’ needs How well caregivers managed patients’ pain How well caregivers explained patients’ medications to them How clean and quiet the hospital was How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions) The survey also asks patients to give an overall satisfaction rating to their hospital stay.

Posted on: April 29, 2011

Medicare To Begin Basing Hospital Payments On Patient-Satisfaction Scores

From Kaiser Health News:

The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying patient opinions to payments will result in better care. But many hospital officials are wary, arguing the scores don’t necessarily reflect the quality of the care and are influenced by factors beyond their control.

Medicare has been publishing patient-satisfaction scores on its Hospital Compare website since 2008, but hasn’t used them to adjust payments. Under CMS’s “value-based purchasing” proposal, Medicare will begin withholding 1 percent of its payments to hospitals starting in October 2012. That money — $850 million in the first year — will go into a pool to be doled out as bonuses to hospitals that score above average on several measures. The agency’s final rule is due out soon.

Illinois ERs Compete for Patients

From JEMS:

Springfield-area residents are being wooed to choose one emergency room over another.

St. John’s Hospital, which has lost ground to Memorial Medical Center over the past half-dozen years when it comes to the number of patients seeking care in the ER, launched its “ER Care Times” campaign a few months ago, complete with billboards, signs on buses and a prominent spot on the St. John’s website.

The St. John’s campaign is the first ER promotional effort by the hospital in several years.

Memorial, which is almost constantly advertising its ER, recently kicked off its newest marketing effort – “Memorial ER Stories” – in which it solicits testimonials from former patients for promotional use in exchange for a free T-shirt.

ResQPump

From Neatorama:

After one man went into cardiac arrest and his family successfully performed CPR on him with a toilet plunger, Advanced Circulator Systems developed the ResQPump. It’s a machine that regulates chest compressions and airflow during the resuscitation process:

According to a study published in The Lancet this winter, the ResQPump, which is used for chest compressions, and the ResQPOD, which prevents too much air from entering the lungs during CPR, could increase certain cardiac-arrest victims’ chances of survival by 50 percent.

The ResQPump works like a toilet plunger, but while decompressing it can draw air back into the lungs. The ResQPOD, cleared by the FDA in 2003, regulates airflow by creating suction in the chest, which draws blood up into the brain.

“Alcohol poisoning keeps ER busy”

From the Sioux City Journal:

“You could literally have permanent brain damage from a single alcohol poisoning episode and never be the same,” said Dr. Travis Brownell, an emergency room physician at Mercy Medical Center – Sioux City, where the E.R. sees an alcohol-related case every day and “just straight alcohol poisoning” every Friday and Saturday night.

Michigan Patient Emits Poisonous Gas

From JEMS:

A Michigan hospital said a patient believed to have ingested rodent poison was found to be emitting potentially harmful gasses and has been isolated.

Lauren Jones, a spokeswoman for St. Joseph Mercy Hospital in Ann Arbor, said the man has been isolated in his room and is being monitored by Washtenaw County Hazardous Material Team workers, the Detroit Free Press reported Tuesday.

ER doctor delivers baby in hospital parking lot

From The Signal:

Lt. Col. Timothy Barron knows emergencies can strike at any moment. It is something he’s learned during his time in the military and as the department head of DeWitt Army Community Hospital’s Emergency Room, here.

As a result, he rarely takes breaks. So, it was no surprise to Barron — and a little bit of Murphy’s Law — that an emergency would strike seconds after Barron decided to grab a cup of coffee from the hospital dining facility.

“We look out the window and see a nurse waving her hands (in the driveway loop outside of the ER) next to a car. So, we rush out and find a woman giving birth in the front passenger seat,” Barron said, referring to the events of April 6. “The baby’s head and shoulders were out, so I helped get the torso and legs.”

The exhaustion of emergency physicians, and its toll on patients and family

From Kevin MD:

When I applied for residency, the literature suggested that the burnout associated with practicing EM applies primarily to physicians who weren’t trained in this specialty. But a recent longitudinal study of EM physicians by the American Board of Emergency Physicians shows something different: It reports that one third of EM physicians report burnout. Other studies suggest an increased incidence of breast cancer, obesity and other comorbidities in night shift workers. One survey of EPs over 55 reported several “age related concerns”;  74% found it more difficult  to recover from night shifts, 44% reported a higher level of emotional exhaustion after shifts, 40% were less able to manage high patient volumes, and 36% reported less ability to manage the stress associated with EM practice.

Anecdotal evidence supports these findings. Many of my friends and colleagues who are more than eight years out of residency, claim to be exhausted. One friend has fallen asleep at the wheel, and many complain of bickering at home with spouses and kids because they have no patience after working late evening and night shifts. Some have gained a significant amount of weight and developed hypertension. Others say that days can pass without seeing their children because of the wacky hours. Several have decreased their clinical time significantly or have left clinical medicine completely.

ER Visits Keep Increasing, Survey Finds

From the Hartford Courant:

One of the most frequently mentioned goals of health care reform is reducing expensive emergency room care, but a new survey of emergency room doctors indicates that this will be difficult to achieve.

More than 80 percent of Connecticut doctors responding to a new poll by the American College of Emergency Physicians said that emergency visits are increasing at their hospitals, and more than 95 percent expect increases next year.

These results closely track the national findings of the poll, which was conducted by the American College of Emergency Physicians in March. The group sent an email questionnaire to 20,687 emergency physicians across the country, and 1,768 replied.

“Despite health care reform, the survey concludes that visits to emergency rooms are going to increase across the country, and that having health insurance doesn’t guarantee access to medical care,” said Dr. Darria Long, emergency physician at Yale Department of Emergency Medicine in New Haven.

Kevin MD’s take on Dr. Meisel’s article in TIME

From Kevin MD:

Drs. Pines and Meisel argue against blunt solutions, like the one being proposed in Washington state. Denying ER care to patients can lead to unintended consequences, like the aforementioned societal costs, along with the risk of increased malpractice litigation.

Furthermore, by targeting the ER, such policies also miss the true cause of the problem: a profound lack of primary care access.