Minnesota seeks input on pandemic preparations

From Modern Healthcare:

Responding to warnings that a worldwide outbreak of a deadly respiratory virus is unavoidable, Minnesota health officials have invited the public to respond to a specialty panel’s recommendations on how the state should prepare for a severe flu pandemic.

The project was organized by the Minnesota Center for Health Care Ethics and the University of Minnesota Center for Bioethics under a contract with the Minnesota Department of Health. A panel of health ethicists, healthcare providers, community leaders and representatives from government and business developed preliminary recommendations on necessary resources, as well as suggested strategies for implementation. Both preliminary reports are posted on the state Health Department’s Web site.

Negative outlook on not-for-profits

From Modern Healthcare:

Fitch Ratings reiterated its negative outlook for not-for-profit hospitals as the nation’s recession and credit crunch drag on. The agency lowered its outlook from stable in early December 2008. Rising unemployment, poorly performing investments, and costly and limited capital continue to stress hospital balance sheets, analysts said. Additionally, not-for-profit hospital credit ratings will more often drop than climb through July 2010 or January 2011, according to the analysts.

Strain on public and private budgets is expected to curb hospital revenue as state deficits squeeze Medicaid spending and layoffs continue to add more to the ranks of unemployed and uninsured. Consumer healthcare spending is also expected to decline. Not-for-profit hospital cash cushions plummeted significantly in 2008 as equity and other investments tumbled, particularly in the final months of the year. Hospital reserves and financial flexibility entered 2009 worse off, but are expected to be somewhat stable through the year, the report said.

Meanwhile, hospitals that borrowed from short-term investors, issuing debt known as variable-rate demand bonds, face heightened risk of being forced to rapidly pay back debt. Dwindling cash reserves could drop below bond covenants. The short-term debt often requires cash or credit backing from a bank, which has grown expensive and scarce because of demand and the struggling banking industry.

Beyond Fee-for-Service: Paying Doctors for ‘Episodes of Care’

From the Wall Street Journal:

When you pay doctors for every procedure they do, there’s an incentive for unnecessary treatments. There’s a financial reward for fixing problems that better care might have prevented. And there’s no incentive for doctors to prevent complications.

On the other hand, few people want to go back to capitation — paying a single, annual fee for all of a patient’s care. That’s been criticized for leading to undertreatment.

So a lot of powerful people are looking toward a middle road: Paying a single, bundled fee for an “episode of care” such as a hip implant or a few months of treatment for cancer or a chronic disease.

House Stimulus Bill Excludes Critical Access Hospitals from HIT Incentives

Nearly thirteen-hundred Critical Access Hospitals (CAHs) that serve over fifteen million Americans in small, mostly rural, communities are excluded from the new health information technology incentives in the proposed Economic Recovery and Reinvestment Act (in H.R. 598). The draft language in the Act effectively excludes CAHs from receiving incentives for EMR adoption even though CAHs average just 1.3 on the HIMSS EMR adoption scale, while General Medical/Surgical hospitals average 2.4. (The HIMSS EMR adoption scale is the nationally recognized standard scale for determining provider EMR adoption rates)

Our smallest hospitals and the rural communities they serve are barred from the vast majority of the Act’s Health Information Technology (HIT) investment, which will revolutionize (1) HIT adoption, (2) HIT-related quality reporting and evaluation, and (3) healthcare information exchange.

It’s difficult to imagine how this could have happened when many HIT advocates have indicated the importance of small hospital inclusion. According to the well known E-Health Initiative, “Special attention should be paid to those with little access to capital, particularly in the current economic environment, including small physician practices, hospitals, and those who support underserved communities.” Rather than receiving special attention, small hospitals and the communities they serve have been effectively shunned from participation in the future of HIT-driven, quality-focus healthcare.

The rationale for this policy decision is difficult to understand. While certainly behind larger hospitals, CAHs throughout the country have shown they are capable of substantial Electronic Medical Record (EMR) adoption, with adoption increasing. Many inpatient EMR vendors that serve CAHs have been certified by the Certification Commission for Healthcare Information Technology and offer the functionality to take CAHs to the highest level of EMR adoption. But this takes an investment out of reach for many CAHs. Due to the specific challenges that small hospitals face, EMR implementation, a prerequisite for clinical information exchange, is particularly important in the small hospital setting.

If not addressed, this flaw in this legislation will result in grave damage to rural and small providers/communities. As most hospitals are subsidized to implement comprehensive EMRs, small hospitals, already lagging, will get even farther behind. The continuity of care between small hospitals and their tertiary partners will remain fractured, since clinical data will not be available for exchange. Small hospitals will in many cases be forced to rely on the large hospitals that have been subsidized, which will strike at community hospital independence. Most important, the underserved residents in small and rural communities will be largely deprived of the efficient, quality healthcare that it is the goal of this legislation to deliver to all other Americans. CAH exclusion in the Economic Stimulus Bill should be reconsidered in favor of HIT for all providers and the communities they serve.

Tim Size, Executive Director

Rural Wisconsin Health Cooperative

The Joint Commission adds patient satisfaction to Quality Check Web site

The Joint Commission last week announced hospitals and consumers can now find patient satisfaction ratings on www.qualitycheck.org, the Web site that evaluates more than 15,000 accredited healthcare organizations based on compliance with the National Patient Safety Goals and National Quality Improvement Goals.

Patient satisfaction ratings are based on measurements including communication with doctors, communication with nurses, hospital staff responsiveness, hospital atmosphere, pain management, communication about medications, and discharge information.

Quality Check’s measurement of patient satisfaction joins a list of other ratings, including 30-day mortality rates for heart attack, heart failure, and pneumonia, already available on the Web site.

Patient satisfaction information on Quality Check will be updated each quarter.

Using information from Google when credentialing medical staff applicants

Without a doubt, Google and other search engines have transformed the way credentialers verify medical staff applicants’ histories. Not only can search engines, including the online Credentialing and Privileging Desktop Reference, help you find a missing medical school fax number, some can also reveal myriad details about a physician’s past personal or professional life. Work-related incidents, personal mishaps, lawsuits, and other facts often turn up in a simple Google search.

Indeed, running a Google query on medical staff applicants should not be skipped in the event it does reveal information not contained on the application. Credentialers should, however, exercise discretion in how they use this information.

Although any disconcerting information discovered about an applicant on a Google search should be treated as a red flag on the application, any information for which the Internet is the sole source should never be considered conclusive or the justification for a denial of privileges or other action.

States Wrestle Over Medicaid Funds in Stimulus Package

From the Wall Street Journal Health Blog:

The $819 billion economic stimulus package now heads to the Senate after passing the House in a 244-188 vote, without a single Republican saying “yea.” Now it heads to the Senate, where one of the sticking points is expected to be how funds for Medicaid will be distributed.

The WSJ explains that Democrats from rural and urban areas are wrestling over the formula to divvy up $87 billion in Medicaid funding. In the House bill, 52.5% of the funds would be doled out under the typical formula that’s used annually, and the rest would be given out under a new “bonus” program that favors states with high unemployment rates.

This is worrying the folks in poor rural states where the unemployment numbers are already high, but where the rate of decline in jobs isn’t as steep as in urban areas. “We are getting killed,” said Sen. Kent Conrad of North Dakota.

C Difficile in Exam Rooms, on Equipment…

From Science Direct:


Numerous studies have demonstrated that environmental surfaces in the rooms of patients with Clostridium difficile infection (CDI) are often contaminated with spores. However, less information is available regarding the frequency of contamination of environmental surfaces outside of CDI isolation rooms.


We performed a point-prevalence culture survey for C difficile in rooms of patients not in isolation for CDI, in physician and nurse work areas, and on portable equipment, including pulse oximetry devices, electrocardiogram machines, mobile computers, and medication distribution carts. Isolates were characterized by assessment of toxin production, polymerase chain reaction (PCR) ribotyping, and PCR for binary toxin genes.


Of 105 nonisolation rooms, 17 (16%) were contaminated with toxin-producing C difficile, with the highest rate of contamination on the spinal cord injury unit (32%). Of 87 surfaces cultured outside of patient rooms, 20 (23%) were contaminated, including 9 of 29 (31%) in physician work areas, 1 of 10 (10%) in nurse work areas, and 9 of 43 (21%) portable pieces of equipment, including a pulse oximetry finger probe, medication carts, and bar code scanners on medication carts. Of 26 isolates subjected to typing, 19 (73%) matched ribotype patterns detected in stool samples from CDI patients and 13 (50%) were epidemic, binary toxin-positive strains.


In the context of a CDI outbreak, we found that environmental contamination was common in nonisolation rooms, in physician and nurse work areas, and on portable equipment. Further research is needed to determine whether contamination in these areas plays a significant role in transmission.

House passes stimulus bill

From Modern Physician:

he Democratic-controlled House approved an $819 billion stimulus bill Wednesday night with spending increases and tax cuts at the heart of the young administration’s plan to revive a badly ailing economy, including more than $80 billion for state Medicaid budgets and more than $20 billion to help doctors and hospitals adopt health information technology.

The vote was 244-188, with Republicans unanimous in opposition despite Obama’s pleas for bipartisan support.

Included is money for traditional job-creating programs such as highway construction and mass transit projects. But the measure tickets far more for unemployment benefits, healthcare and food stamp increases designed to aid victims of the economic downturn.

Charity Care and Non-Profit Status

From the Wall Street Health Blog:

In the latest round of the fight over whether nonprofit hospitals provide enough charity care to justify their tax exemptions, a big Chicago hospital operator is settling a class action suit over what it has charged the uninsured.

Advocate Health Care, which operates a bunch of hospitals in the Chicago area, said today it has agreed to provide charity aid to patients earning up to 400% of the federal poverty level or $82,500 for a family of four, the Chicago Tribune reports. It will provide aid retroactively to people who would have been eligible from November 2000 and on.