How following hospital quality measures can kill patients

Provactive title, eh?

From Kevin MD‘s comments on WhiteCoat’s post:

Here’s what happens when you give so much attention and influence to such a crude instrument.

Following quality measures can make or break a hospital’s reputation, especially if they are being widely advertised. Patients often make health care choices based on whether doctors following quality measures.

However, as these measures are currently constructed, they often ignore the nuance surrounding many cases.

Emergency physician WhiteCoat cites two examples where he failed to follow quality measures, and was labeled “out of compliance” with the guidelines.

Why Hotels Resist Having Defibrillators

From the Wall Street Journal:

If your heart stops suddenly, you may not want to be at a hotel.

Automated external defibrillators — laptop-sized devices that can automatically restart a heart after sudden cardiac arrest — are now required equipment on commercial airliners and have saved lives at airports, casinos, health clubs and many public buildings. But hotels have resisted installing them, citing potential liability issues.

Stimulus law will improve Minnesota’s ability to obtain additional Medicaid matching funds

From the Minnesota Hospital Association:

Key provisions of the federal stimulus bill that President Obama signed into law last Tuesday will mean a temporary increase in Minnesota’s federal Medicaid match.

Under the $86.6 billion American Recovery and Reinvestment Act, all states will receive a temporary 6.2 percent increase via the federal Medicaid assistance percentage (FMAP) increase. Two-thirds of the total funds will be distributed that way.

The remaining one-third of the money will be allocated to states that experienced a significant increase in their unemployment rate between 2006 and 2008. The rate increase a state will receive depends on how much its unemployment rate went up in that period. The Minnesota Hospital Association (MHA) has determined that Minnesota will likely qualify for that additional increase, which totals 3.7 percent.

As a result of both measures, Minnesota’s federal Medicaid match rate would go from 50/50 to approximately 60/40, which equals a 20 percent overall increase.

Under another provision important to Minnesota hospitals, both prospective payment hospitals and critical-access hospitals would receive additional funding for electronic health record systems. That provision will provide increased reimbursement through Medicare and Medicaid incentive payments. MHA will provide additional information on that component once it becomes available.

Safety Net Clinics

From Kevin MD:

Patients on Medicare and Medicaid tend to utilize the health care system more frequently.

Combined with the fact that an increasing number of physicians are closing their doors to such patients, the so-called “safety net” clinics and hospitals are finding themselves with much more work than they can handle.

In this case in California, one such clinic was seriously considering shutting its doors to Medicare.

White House 2010 budget outline includes hospital provisions

From the American Hospital Association:

President Obama today submitted to Congress a fiscal year 2010 budget outline that would create a reserve fund of more than $630 billion over 10 years to help pay for health care reform. Half of the reserve fund would come from savings in health care programs, including proposals to bundle Medicare payments for hospital and post-acute care ($17.84 billion in savings), reduce payments to hospitals with certain readmission rates ($8.43 billion), and link a portion of inpatient hospital payment to performance on specific quality measures ($12.09 billion). The budget outline also cites the need to address physician self-referral to facilities in which they have a financial interest. AHA President and CEO Rich Umbdenstock said, “We commend President Obama for making health reform a top priority in his budget blueprint. However, we are concerned about any cuts that would affect the work hospitals do for their communities during this economic downturn. We remain ready to work with the president and Congress to strengthen health care in America.”

Bill aims to enhance access to emergency care

From Modern Healthcare:

A bipartisan group of House and Senate members have reintroduced legislation to help improve access to emergency medical services.

The “Access to Emergency Medical Services Act” calls for the creation of a national bipartisan commission on access to emergency medical services to examine factors that affect the delivery of care in emergency departments. In addition, the legislation asks the CMS to develop standards, guidelines and measures to address boarding—the placing of patients in beds in the emergency department instead of inpatient beds—and ambulance diversion.

Sponsors include Sens. Debbie Stabenow (D-Mich.) and Arlen Specter (R-Pa.) and Reps. Bart Gordon (D-Tenn.) and Pete Sessions (R-Texas).

The American College of Emergency Physicians plans to urge Congress to hold hearings on the access problems facing patients who visit emergency departments. The legislation, which had been introduced in the previous Congress, gained over 187 co-sponsors in both houses of Congress. Lawmakers in the new Congress are taking early action to re-introduce the bill “and we have every confidence that it will pass,” ACEP President Nick Jouriles said in a written statement.

The legislation would increase Medicare reimbursement for emergency department-related care by 10%, something that would apply to on-call physicians as well, Stabenow said.

Obama Budget Boosts Loan Repayments for Docs and Nurses

From the Wall Street Journal Health Blog:

President Obama’s budget blueprint outlines more on his ideas for health care, including cancer research and addressing the nursing shortage. Below are some more highlights to add on to what we offered this morning.

Doctor and Nurse Shortages: Shortages of nurses and the dwindling ranks of primary-care physicians are among the gnawing issues in health care. The budget proposal offers up $330 million “to address the shortage of health-care providers in certain areas.” Among other things, it expands loan-repayment programs for doctors, nurses and dentists who agree to practice in medically underserved areas. It also aims to bolster nursing schools.

Multiple ED Visits for Kids May Signal Neglect

From MedPage Today:

Kids with two or more injury-related medical visits within a year were more likely to have been reported for child maltreatment and have substantiated reports than those with only one visit, Patricia G. Schnitzer, Ph.D., of the University of Missouri, and colleagues reported online in the Journal of Emergency Medicine.

Neglect — including inadequate supervision — is the most common type of child maltreatment, the researchers said. “Many more injuries are related to neglect than to inflicted injury,” they said, although such issues are not commonly documented in the ED record.

So to assess the relationship, the researchers looked at emergency department data on 50,068 children under age 5 with 56,364 injury visits from Jan. 1, 2000 to Dec. 31, 2000. The average age was 2 and 61% were younger than 3.

The researchers found that children with two injury-related visits in a year were nearly twice as likely as children with only one visit to have a maltreatment report filed with the state’s Child Protective Services.

ACEP AEMSA Bill Introduced in Congress

From the EDPMA:

The American College of Emergency Physicians (ACEP) has worked to re-introduce the Access to Emergency Medical Services Act (AEMSA) in the current Congress.  In the Senate, the legislation was introduced by Sens. Debbie Stabenow (D-Mich.) and Arlen Specter (R-Pa.).  In the House the legislation was introduced by Reps. Bart Gordon (D-Tenn.) and Pete Sessions (R-Texas).  EDPMA had endorsed the previous version of this bill in the prior Congress and will work through the Medicare Payment Task Force to determine if similar actions are appropriate for this legislation.

Officials: Budget to include $634 billion health-care ‘reserve fund’

From CNN:

A senior administration official told CNN Wednesday that the proposed budget to be released Thursday will include a $634 billion health-care “reserve fund,” which is intended to help pay to overhaul the nation’s health-care system over 10 years.

President Obama is expected to unveil his fiscal year 2010 budget on Thursday.

One of the officials said the administration sees health care as key to the nation’s fiscal health and called the fund a down payment on Obama’s effort to reform health care.

Money for the reserve fund is expected to come from limiting tax breaks for the wealthy and tightening payments to insurers, hospitals and physicians.

OMB Director Peter Orszag told CNN on Tuesday that a massive overhaul of the health-care system can be achieved this year and that it should provide “universal coverage.”