Archive for the ‘Hospitals’ Category

Electronic Health Records Improve Ambulatory Care

17 Oct

According to a new study published in the Journal of General Internal Medicine, electronic health records (EHRs) significantly improve the quality of community-based ambulatory care.

Lisa M. Kern, M.D., M.P.H., of Weill Cornell Medical College in New York City, conducted a cross-sectional study with her colleagues of 2008 data for 466 general internists, pediatricians, and family medicine practitioners in ambulatory practices in New York. They found that 44 percent of the physicians had adopted electronic health records and 56 percent continued to use paper records for the total of 74,618 patients represented by the physicians in the study.
There were quality measures for nine types of care: eye exams, hemoglobin testing, cholesterol testing, renal function testing for diabetics, colorectal cancer screening, chlamydia screening, breast cancer screening, pediatric sore throat testing, and treatment for children with upper respiratory infections.
Physicians who used EHRs provided higher rates of care than physicians who used paper records, with a significant improvement in four measures: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.
“We found that EHR use is associated with higher quality ambulatory care. This finding occurred in a multi-payer community with concerted efforts to support EHR implementation,” wrote the authors. “In contrast to several recent national and statewide studies, which found no effect of EHR use, this study’s finding is consistent with national efforts to promote meaningful use of EHRs.”

How Patients Can Help ACOs Save Money

16 Aug

There are many ways ACOs can save money in the healthcare industry from an administrative perspective. But some of that savings will depend on patients being faithful to their medications, according to a new report.

For example, the report found that if more diabetics took their medication, a Medicare ACO with 10,000 seniors could save $1.1 million on emergency room and hospital visits every year. While thay may not sound like a lot on the national level, that’s only one example. And when you look at it on a national level, the study conservatively estimates $4.7 billion savings a year overall and $2.2 billion to Medicare. The estimates are deemed conservative because the study only included the savings from the cost of hospital stays and emergency room visits, not outpatient care.
While it’s ideal to hope that people will do this independently, there has to be an outside catalyst, if patients do not keep up with their medications already armed with the basic knowledge that it will improve or maintain their health. The researchers did n’t estimate the cost of interventions to boost drug adherence.
“As accountable care organizations and other similar entities form and take greater responsibility for the health and spending of an entire population, focusing on better adherence may be a high-yield activity,” wrote the authors in their report.
The study, published in the journal Health Affairs, examined how closely patients follow their prescriptions. The researchers did so by analyzing three years of data for 135,640 diabetes patients. They tracked changes in prescription use during the first two years (2006 and 2007) and examined hospital and emergency room visits in the third year (2008). They also took into account that some patients could be more ill than others. 
For those patients who didn’t follow their prescriptions during the first year, but who properly took medications in year two, the likelihood of a hospital or emergency room visit dropped 13 percent. The average cost per emergency room visit and hospital stay were $1,502 and $11,575 respectively.
Those patients who started on the right foot and took their medication correctly, but did not continue to do so, the likelihood of a hospital or emergency room visit jumped 15 percent. 
As for how to improve adherence to prescriptions, unfortunately the study did not go down that road.

Medicare Coverage Problems Arise with More Observation Stays

13 Jun


Hospitals all over the U.S. are labeling their patients as outpatients under observation. According to a new study, that is causing problems for people who are being covered by Medicare.
Over the last 10 years, the Center for Medicare & Medicaid Services (CMS) has put a greater emphasis on detecting Medicare fraud and curbing costs via hospital audits, which includes audits of short hospitalizations. 
According to research from a Brown University study (and maybe some good old fashioned common sense), this has lead to an increase in patient observation stays (different from a hospitalization), since hospitals can avoid an audit if they do so. The researchers found a 34 percent increase in the ratio of observation stays to inpatient hospitalizations among Medicare beneficiaries between 2007 and 2009. Also during that timespan, there was an 88 percent jump in Medicare patients held for observation stays for 72 hours or more.
Trying to reduce the number of inpatient hospitalizations may have the good intention of reducing fraudulent or medically unnecessary healthcare expenditures, patient advocates say this leaves Medicare recipients in the lurch with large and unexpected expenses.
Hospitals walk a difficult tightrope between criticism on the patient advocacy front when they appear to increase observation stays at the expense of patients and auditor with the CMS if they don’t.
The California Hospital Association states on their website that hospitals “face criticism from patients and CMS over the perceived use of observation status as a substitute for inpatient admissions, but risk penalties from CMS auditors and prosecutors when auditing admissions of short inpatient stays.”

Hospitals Lose Millions to Cancelled Appointments

24 May


While patients may not think much of not showing up for an appointment or canceling, it can have serious long-term consequences for hospitals and their bottom line. According to researchers involved in a 2009 study at Tulane University Medical Center, 327 of 4,876 (6.7 percent) scheduled elective outpatient surgeries were cancelled, which ended up costing the hospital almost $1 million for the year.
Since surgeries are responsible for about 60 percent of the hospital’s revenue, that loss had a major financial effect, says study author Sabrina Bent, MD, MS, clinical associate professor of anesthesiology and director of research at the Tulane University Department of Anesthesia, in New Orleans.
However, the researchers pointed out that patients who have a preoperative visit with an anesthesiologist are considerably more likely to keep their appointment in the operating room.
“People need to recognize that there is a cost to cancelled surgeries that is not insignificant,” said Dr. Bent, who presented the findings at this year’s American Society of Anesthesiologists Conference on Practice Management.
Much of cost associated with cancelled surgery stems from the fact that hospitals can’t fill in those slots with other surgical on short notice. 
One step in minimizing surgery cancellations is understanding why they happen in the first place. According to Dr. Bent, 30 percent of patients in the study didn’t show for their surgery due to transportation problems, confusion over the appointment date, forgetting about the appointment, among other reasons.
While those issues may be difficult to remedy, about a third of the cancellations were actually due to internal hospital issues, including a lack of beds or equipment and scheduling errors. Sometimes equipment is needed in two operating rooms at once, equipment fails, or there is no room in the ICU.
Researchers’ Recommendations
  • Dr. Bent and her colleagues recommend that hospitals make sure all patients have a preoperative visit with an anesthesiologist, since they found those patients had a 7 percent advantage in the cancellation rate (11 percent vs. 4 percent).
  • Make sure patients are medically ready for surgery and that they receive the proper preoperative instructions for the day of the procedure.
  • Improve equipment and resource allocation.
  • Hospitals should focus on areas they can have the biggest impact, such as the specialities with the highest cost associated with their cancellations. The top two were neurosurgery and urology, with an average cost per case of 5,962 and $4,758 respectively.
“I think this study suggests that it is reasonable for medical centers to bear a significant cost to maintain the anesthesia preoperative clinic,” said Dr. Glick, MD, MBA, associate professor of anesthesia and critical care at the University of Chicago. “It enables them to save more money down the line, when surgeries are not cancelled.”

CMS Proposes 2013 Pay Rate Hike for Hospitals

30 Apr


The Centers for Medicare & Medicaid Services (CMS) just issued a proposed rule to update 2013 Medicare, which includes a payment rate increase of 2.3 percent for inpatient stays at general acute care hospitals. The increase would raise total Medicare spending for inpatient hospital care by about $175 million.
According to a CMS statement: “The rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare’s operating payments to acute care hospitals by approximately 0.9% in fiscal year 2013.”
However, there is also a provision to reduce payments by two percentage points beginning in fiscal 2013 for hospitals that have excess readmissions for MI, heart failure, and pneumonia.
CMS is also proposing medical coding additions to the existing Vascular Catheter-associated Infection HAC category, ICD-9:
– 999.32 Bloodstream infection due to central venous catheter
– 999.33 Local infection due to central venous catheter
Those LTCHs that fail to meet the quality measures will see payment rates cut starting in 2016.
The proposed rule would also include a one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an ongoing research initiative to redefine the role of LTCHs in the Medicare program. Currently, the legislative moratorium expires at the end of 2012.
The American Hospital Association (AHA) responded by saying: “While we commend CMS for delaying the full implementation of the 25 percent rule for long-term care hospitals (LTCHs), we are troubled that the delay does not fully apply to all LTCHs this year. Leaving the proposal as is could arbitrarily prohibit some patients from receiving needed long-term care.”
A final version of the proposal is expected to arrive on August 1. CMS will accept comments on the proposed rules until June 25.

Thomson Reuters Names its 100 Top Hospitals for 2011

18 May
Thomson Reuters has released its Thomson Reuters 100 Top Hospitals list for 2011. Far from being an arbitrary award, the top 100 hospital are run so well that researchers say if all Medicare inpatients received the same level of care as those in the top 100 hospitals, the following would happen:
– Almost 116,000 additional patients would survive every year.
– Over 197,000 patient health complications could be avoided each year.
– Expense per adjusted discharge would drop by $462.
– The average patient stay would decrease by half a day.
"This year’s 100 Top Hospitals award winners have delivered exemplary results, despite volatility from healthcare reform," said Jean Chenoweth, senior vice president at Thomson Reuters. "The leadership teams at these organizations have dealt with enormous ambiguity, yet remained focused on mission and excellence across the hospital which drove national benchmarks to new highs."
In order to come up with their 100 Top Hospitals, Thomson Reuters researchers evaluated 2,914 short-term, acute care, non-federal hospitals. They used public information from Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. 
The Thomson Reuters 100 Top Hospitals were picked based on the evaluation of 10 performance areas at each hospital: mortality, medical complications, patient safety, average patient stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, post-discharge mortality and readmission rates for acute myocardial infarction (heart attack), heart failure, and pneumonia.
The hospitals were broken down into groups. So, for the sake of brevity, here are five winners from each category (go to for the complete list):
Major Teaching Hospitals
– Advocate Illinois Masonic Medical Center – Chicago, Illinois
– Advocate Lutheran General Hospital – Park Ridge, Illinois
– Baystate Medical Center – Springfield, Massachusetts
– Beth Israel Deaconess Medical Center – Boston, Massachusetts
– Brigham and Women’s Hospital – Boston, Massachusetts
Teaching Hospitals
– Aultman Hospital – Canton, Ohio
– Beaumont Hospital, Troy – Troy, Michigan
– Bronson Methodist Hospital – Kalamazoo, Michigan
– Bryn Mawr Hospital – Bryn Mawr, Pennsylvania
– Carle Foundation Hospital – Urbana, Illinois
Large Community Hospitals 
– Advocate Good Samaritan Hospital – Downers Grove, Illinois
– Allegiance Health – Jackson, Michigan
– Baylor All Saints Medical Center at Fort Worth – Fort Worth, Texas
– Beverly Hospital – Beverly, Massachusetts
– Boone Hospital Center – Columbia, Missouri
Medium Community Hospitals
– Augusta Health – Fisherville, Virginia
– Aurora Sheboygan Memorial Medical Center – Sheboygan, Wisconsin
– Blanchard Valley Hospital – Findlay, Ohio
– Cleveland Clinic Florida – Weston, Florida
– Columbus Regional Hospital – Columbus, Indiana
Small Community Hospitals
– Andalusia Regional Hospital – Andalusia, Alabama
– American Fork Hospital – American Fork, Utah
– Baylor Medical Center at Waxahachie – Waxahachie, Texas
– Central Michigan Community Hospital – Mount Pleasant, Michigan
– Flaget Memorial Hospital – Bardstown, Kentucky