Archive for the ‘hospitals’ Category

The Growing Role of Emergency Departments in Hospital Admissions

July 12, 2012 Comments off

The Growing Role of Emergency Departments in Hospital Admissions

Source: New England Journal of Medicine

Growing use of U.S. emergency departments (EDs), cited as a key contributor to rising health care costs, has become a leading target of health care reform. ED visit rates increased by more than a third between 1997 and 2007, and EDs are increasingly the safety net for underserved patients, particularly adult Medicaid beneficiaries.1 Although much attention has been paid to increasing ED use, the ED’s changing role in our health care system has been less thoroughly examined. EDs serve as a hub for prehospital emergency medical systems, an acute diagnostic and treatment center, a primary safety net, and a 24/7 portal for rapid inpatient admission. Approximately a quarter of all acute care outpatient visits in the United States occur in EDs, a proportion that has been growing since 2001.2 We examined the proportion of hospital admissions that come through the ED, hypothesizing that use of the ED as the admission portal had increased across conditions.

We analyzed data from the Nationwide Inpatient Sample (NIS), the largest all-payer database of U.S. inpatient care, from 1993 to 2006 (the most recent year for which the ED admission data are available on HCUPnet, an interactive Web-based tool that uses data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality). The NIS contains data from approximately 8 million hospital stays each year and is weighted to produce national estimates. We used HCUPnet to query the NIS regarding trends in the 20 clinical conditions for which patients were most frequently admitted to the hospital in 2006. Clinical Classifications Software was used to group the conditions into clinically meaningful categories. We excluded two conditions for which patients are rarely admitted through the ED (osteoarthritis and back problems), one psychiatric condition that was not consistently coded in claims data (affective disorder), and four obstetrical diagnoses that are generally evaluated in other care settings, such as labor-and-delivery triage areas (liveborn infant, maternal birth trauma, other complications of birth, other complications of pregnancy).

The number of hospital admissions increased by 15.0%, from 34.3 million in 1993 to 39.5 million in 2006; admissions from the ED increased by 50.4%, from 11.5 million to 17.3 million. The proportion of all inpatient stays involving admission from the ED increased from 33.5 to 43.8% (P<0.001). In 12 of the 13 conditions for which patients were most frequently admitted and that met our inclusion criteria, an increased proportion of admitted patients came through the ED (P<0.001), regardless of the trend in overall admissions; the exception was coronary atherosclerosis, for which rapid “rule-out” protocols and ED-based chest-pain observation units have reduced the need for inpatient admission.

Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009

June 12, 2012 Comments off

Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein of the body; pulmonary embolism (PE) occurs when a clot breaks free and enters the arteries of the lungs. DVT and PE comprise venous thromboembolism (VTE), an important and growing public health concern (1,2). Hospitalization is a major risk factor for VTE, and many VTE events that occur among hospitalized patients can be prevented (2,3). A new program of the U.S. Department of Health and Human Services (Partnership for Patients: Better Care, Lower Costs) aims to reduce the number of preventable VTE cases in hospitals (4). To estimate the number of hospitalizations with VTE each year in the United States, CDC analyzed 2007–2009 data from the National Hospital Discharge Survey (NHDS). The results of that analysis determined that an estimated average of 547,596 hospitalizations with VTE occurred each year among those aged ≥18 years in the United States. DVT was diagnosed in an estimated annual average of 348,558 hospitalizations, and PE was diagnosed in 277,549; both DVT and PE were diagnosed in 78,511 hospitalizations. Estimates of the rates of hospitalizations with VTE were substantially higher among adults aged ≥60 years compared with those aged 18–59 years. These findings underscore the need to promote implementation of evidence-based prevention strategies to reduce the number of preventable cases of VTE among hospitalized patients.

Center to Advance Palliative Care

June 4, 2012 Comments off
Source:  Robert Wood Johnson Foundation
Dates of Support: 1999–2011
Field of Work: Palliative and end-of-life care
Problem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.
Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.
To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.
Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
  • By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
  • The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
  • In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.

Helping Hospitals Deliver Better Care: A New Toolkit for Quality Improvement

June 3, 2012 Comments off
Source:  RAND Corporation

A team from RAND and the University HealthSystem Consortium developed a toolkit to help hospitals enhance their quality improvement efforts using quality indicators from the Agency for Healthcare Research and Quality.

Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis

April 27, 2012 Comments off

Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis

Source:  British Medical Journal

In the 30 days after hospital discharge, hospital utilisation is common and costly. This study evaluated the association between gender and hospital utilisation within 30 days of discharge.


Secondary data analysis using Poisson regression stratified by gender.


737 English-speaking hospitalised adults from general medical service in urban, academic safety-net medical centre who participated in the Project Re-Engineered clinical trial ( identifier: NCT00252057).

Main outcome measure:

The primary end point was hospital utilisation, defined as total emergency department visits and hospital readmissions within 30 days after index discharge.


Female subjects had a rate of 29 events for every 100 people and male subjects had a rate of 47 events for every 100 people (incident rate ratio (IRR) 1.62, 95% CI 1.28 to 2.06). Among men, risk factors included hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.55, 95% CI 2.38 to 5.29), being unmarried (IRR 1.72, 95% CI 1.12 to 2.64), having a positive depression screen (IRR 1.53, 95% CI 1.09 to 2.13) and no primary care physician (PCP) visit within 30 days (IRR 1.64, 95% CI 1.08 to 2.50). Among women, the only risk factor was hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.08, 95% CI 1.86 to 5.10).


In our data, male subjects had a higher rate of hospital utilisation within 30 days of discharge than female subjects. For men—but not for women—risk factors were being retired, unmarried, having depressive symptoms and having no PCP visit within 30 days. Interventions addressing these factors might lower hospital utilisation rates observed among men.

Maternity special: How birth was hijacked

April 7, 2012 Comments off
Source:  Ecologist
So you want kids, do you? At the Ecologist, we’re not going to preach about the impending population bomb, and its devastating impact on scarce resources and the earth’s changing climate. At least, not for now. No, we want to talk about the joys of having children. Becoming a parent is the beginning of the roller coaster ride of a lifetime. But when the thrill is gone, we’re left with worry and white knuckles. Childbirth, one of life’s most empowering experiences, has been hijacked. It’s become institutionalised, taken over by technology, exiled from communities into hospitals and overhyped on TV dramas by scare-mongering pundits.
As we don’t see it happening in our daily lives – around two per cent of births in England are home births – it is no longer part of our communities. This means that, especially for women, what we know about childbirth, before we experience it ourselves, is through stories. And stories are primarily about fear.

Navigating the ICD-10 Transition: Implementation imperative for hospitals and medical groups

April 2, 2012 Comments off

Navigating the ICD-10 Transition: Implementation imperative for hospitals and medical groups
Source: Deloitte

On February 16, 2012, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that “HHS will initiate a process to postpone the date” by which certain health care entities have to comply with ICD-10. While there is uncertainty on a new compliance date, the transition to the ICD-10 coding set presents opportunities, benefits, and challenges that providers should address whether the implementation date is set for 2013, 2014, or beyond.

As organizations review their implementation plans based on scenarios that could play out with an extension, leaders of hospitals and medical groups should keep in mind that regardless of the compliance date, the transition to ICD-10 requires extensive planning and coordination across the organization. Organizations that have completed their ICD-10 readiness assessments have discovered that the road forward presents enterprise-wide challenges that require both a strategic and tactical solution if they plan to leverage benefits from the transition.

This article explores strategic decisions and leading practices for ICD-10 implementation across four key areas: project governance, technology, finance, and operations.

+ Full Document (PDF)

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States

April 2, 2012 Comments off
Source:  British Medical Journal
The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended.

The Long-Term Effect of Premier Pay for Performance on Patient Outcomes

March 31, 2012 Comments off
Source:  New England Journal of Medicine
Pay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes.
We found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality. Expectations of improved outcomes for programs modeled after Premier HQID should therefore remain modest.

Life-threatening germ poses threat across medical facilities

March 16, 2012 Comments off

Life-threatening germ poses threat across medical facilities
Source: Centers for Disease Control and Prevention

Infections from Clostridium difficile (C. difficile), a bacteria that causes diarrhea and other health issues, is a patient safety concern in all types of medical facilities, not just hospitals as traditionally thought, according to a new Vital Signs report today from the Centers for Disease Control and Prevention. While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. difficile infection rates and deaths climbed to historic highs.

C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the health care system. However, the Vital Signs report shows that these hospital estimates may only represent one part of C. difficile’s overall impact.

+ Full Report

Vital Signs: Preventing Clostridium difficile Infections

March 10, 2012 Comments off

Vital Signs: Preventing Clostridium difficile Infections
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Clostridium difficile infection (CDI) is a common and sometimes fatal health-care–associated infection; the incidence, deaths, and excess health-care costs resulting from CDIs in hospitalized patients are all at historic highs. Meanwhile, the contribution of nonhospital health-care exposures to the overall burden of CDI, and the ability of programs to prevent CDIs by implementing CDC recommendations across a range of hospitals, have not been demonstrated previously.

Methods: Population-based data from the Emerging Infections Program were analyzed by location and antecedent health-care exposures. Present-on-admission and hospital-onset, laboratory-identified CDIs reported to the National Healthcare Safety Network (NHSN) were analyzed. Rates of hospital-onset CDIs were compared between two 8-month periods near the beginning and end of three CDI prevention programs that focused primarily on measures to prevent intrahospital transmission of C. difficile in three states (Illinois, Massachusetts, and New York).

Results: Among CDIs identified in Emerging Infections Program data in 2010, 94% were associated with receiving health care; of these, 75% had onset among persons not currently hospitalized, including recently discharged patients, outpatients, and nursing home residents. Among CDIs reported to NHSN in 2010, 52% were already present on hospital admission, although they were largely health-care related. The pooled CDI rate declined 20% among 71 hospitals participating in the CDI prevention programs.

Conclusions: Nearly all CDIs are related to various health-care settings where predisposing antibiotics are prescribed and C. difficile transmission occurs. Hospital-onset CDIs were prevented through an emphasis on infection control.

Implications for Public Health: More needs to be done to prevent CDIs; major reductions will require antibiotic stewardship along with infection control applied to nursing homes and ambulatory-care settings as well as hospitals. State health departments and partner organizations have shown leadership in preventing CDIs in hospitals and can prevent more CDIs by extending their programs to cover other health-care settings.

Pew: More Americans Turning To Costly Hospital Care For Preventable Dental Problems

March 1, 2012 Comments off

Pew: More Americans Turning To Costly Hospital Care For Preventable Dental Problems
Source: Pew Center on the States

Already stressed state budgets are shouldering an extra burden to cover expensive emergency room (ER) treatment for toothaches and other avoidable dental ailments, according to a new report by the Pew Center on the States. A Costly Dental Destination estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009—a 16 percent increase from 2006. Pew concludes that states can reduce hospital visits, strengthen oral health and reduce their costs by making modest investments to improve access to preventive care.

Dental-related hospital visits are fueled by the difficulty that disadvantaged people have getting regular preventive care from dentists and other types of providers. In 2009, 56 percent of Medicaid-enrolled children did not receive dental care—not even a routine exam. The access problem is driven by multiple factors, including a shortage of dentists in many areas of the U.S. and the fact that many dentists do not accept Medicaid-enrolled children.

The cost of ER care can be substantial. For example, in Florida, dental-related, emergency hospital visits produced charges exceeding $88 million in 2010. States are saddled with some of these expenses through Medicaid and other public programs.

+ Full Report

Preventing emergency readmissions to hospital: A scoping review

February 19, 2012 Comments off
The report reviews the evidence and potential for use of ‘emergency readmissions within 28 days of discharge from hospital’ as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns. Reviewed studies suggest that between 5 percent and 59 percent of readmissions may be avoidable. Studies are highly heterogeneous, but based on the evidence reviewed, about 15 percent up to 20 percent may be considered reasonable although previous authors have advised against producing a benchmark figure for the percentage of readmissions that can be avoided. The majority of published studies focus on clinical factors associated with readmission. Studies are needed of NHS organisational factors which are associated with readmission or might be altered to prevent readmission.
The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ‘emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.

Hospital Incident Reporting Systems Do Not Capture Most Patient Harm

January 9, 2012 Comments off
Source:  U.S. Department of Health and Human Services, Office of Inspector General
Hospital incident reporting systems captured only an estimated 14 percent of the patient harm events experienced by Medicare beneficiaries. Hospitals investigated those reported events that they considered most likely to lead to quality and safety improvements and made few policy or practice changes as a result of reported events. Hospital administrators classified the remaining events (86 percent) as either events that staff did not perceive as reportable (61 percent) or as events that staff commonly report but did not report in this case (25 percent).
As a condition of participation in the Medicare program, Federal regulations require that hospitals develop and maintain a Quality Assessment and Performance Improvement (QAPI) program. To satisfy QAPI requirements, hospitals must “track medical errors and adverse patient events, analyze their causes, and implement preventive actions and mechanisms that include feedback and learning throughout the hospital.” To standardize hospital event reporting, AHRQ developed a set of event definitions and incident reporting tools known as the Common Formats. We requested and reviewed incident reports from hospitals regarding patient harm events. We had previously identified these events from a nationally representative sample of Medicare beneficiaries discharged in October 2008.
All of the hospitals we reviewed had incident reporting systems designed to capture events; hospital administrators we interviewed indicated that they rely heavily on the systems to identify problems. Hospital accreditors reported that they do not investigate event collection methods, such as incident reporting systems, unless evidence of a problem emerges through the survey process.
Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety.
Therefore, we recommend that AHRQ and CMS collaborate to create and promote a list of potentially reportable events for hospitals to use. We further recommend that CMS provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events. CMS should also suggest that surveyors evaluate the information collected by hospitals using AHRQ’s Common Formats. Additionally, CMS should scrutinize survey standards for assessing hospital compliance with the requirement to track and analyze events and reinforce assessment of incident reporting systems as a key tool to improve event tracking.
We received comments on the draft report from AHRQ and CMS. AHRQ concurred with our recommendation, stating that it will collaborate with CMS to create a list of potentially reportable events and provide technical assistance to hospitals in using the list. CMS also concurred with our recommendations, stating that strengthening hospital reporting systems and practices is an essential component of efforts to prevent patient harm. CMS stated that a voluntary list of adverse events used for informational purposes could be highly beneficial for improving incident reporting practices. CMS also stated that it is developing draft guidance for surveyors regarding assessment of patient safety improvement efforts within hospitals.

Illicit drug related emergency department visits vary by metropolitan area

December 19, 2011 Comments off
Source:  Substance Abuse and Mental Health Services Administration

Major metropolitan areas show significant variation in the rates of emergency department (ED) visits involving illicit drugs. In terms of overall illicit drug-related emergency room visits, Boston has the highest rate (571 per 100,000 population), followed by New York City (555 per 100,000 population), Chicago (507 per 100,000 population), and Detroit (462 per 100,000 population). By comparison the national average was 317 per 100,000 population.

This new report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) was drawn from the agency’s Drug Abuse Warning Network – (DAWN), a public health surveillance system that monitors drug-related emergency department visits throughout the nation. This information was collected from eleven metropolitan areas including Boston, Chicago, Denver, Detroit, Miami (Dade County and Fort Lauderdale Division), Minneapolis, New York (Five Boroughs Division), Phoenix, San Francisco, and Seattle.

Full Report (PDF)

Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008–2009

November 19, 2011 Comments off

Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008–2009
Source: National Center for Health Statistics

Key findings

  • Hospital outpatient department visits attended only by physician assistants (PAs) or advance practice nurses (APNs) increased by 50% from 2000–2001 (10%) through 2008–2009 (15%).
  • The more urban the hospital location, the lower the percentage of visits seen only by PAs or APNs; decreasing from 36% in nonmetropolitan areas to 6% in large central metropolitan areas.
  • A higher percentage of PA- or APN-only visits were to general medicine (21%) and obstetric or gynecology (19%) clinics compared with pediatric (8%) and surgical (5%) clinics.
  • PAs and APNs saw a higher percentage of visits where a new problem was the major reason for the visit (22%) compared with visits for a chronic condition [routine (11%) or flare-up (14%)], or pre- or postsurgery care (6%).

Physician assistants (PAs) are state-licensed health professionals practicing medicine under a physician’s supervision (1,2). Advance practice nurses (APNs) are registered nurses (RNs) with advanced training. PAs and APNs have been expanding in supply and playing increasingly diversified roles in the U.S. health care system (1–3). Nationwide, there were 80,000 PAs and 250,000 APNs in 2008. The majority of APNs are nurse practitioners (NPs) (3). In 2008, 38% of NPs, 58% of nurse midwives (NMs), another type of APN, and 23% of PAs worked in hospital settings (1,3).

Adverse Events in Hospitals: Medicare’s Responses to Alleged Serious Events

November 3, 2011 Comments off

Adverse Events in Hospitals: Medicare’s Responses to Alleged Serious Events (PDF)
Source: U.S. Department of Health and Human Services, Office of Inspector General

We found that Medicare’s system of hospital oversight missed opportunities to address patient safety in its response to alleged serious adverse events, such as medication and surgical errors, physical abuse by hospital staff, and patient suicide.

In response to the Tax Relief and Health Care Act of 2006, OIG released a series of reports regarding adverse events. In those reports, OIG estimated that over one-quarter of hospitalized Medicare beneficiaries were harmed during their hospital stays in October 2008. This report examines Medicare’s responses to alleged serious adverse events. These responses represent important patient safety opportunities, yet little attention has been paid to their role in improving patient safety. Hospitals must meet the Medicare Conditions of Participation (CoP) to participate in Medicare.

On behalf of Medicare, State survey and certification agencies (State agencies) investigate complaints alleging hospital noncompliance with the CoP on behalf of Medicare. Immediate Jeopardy (IJ) complaints are the most serious and may allege adverse events. Also, hospitals often conduct their own investigations of adverse events independently of investigations by State agencies.

Because no national database of adverse events exists, this report uses a random sample of IJ complaints as a proxy for alleged serious adverse events to which Medicare responded. To review the complaints, we used data from CMS, State agencies, hospital accreditors, and the hospitals associated with the complaints.

State agency responses to complaints alleging serious adverse events were generally timely and often found problems. However, State agencies and CMS often failed to review hospitals’ compliance with the CoP on quality assessment and performance improvement (QAPI) and the CoP on the hospital’s governing body; performed little longer term monitoring to verify that hospitals’ corrective actions resulted in sustained improvements; and sometimes failed to disclose the nature of the complaints to the hospitals, thereby limiting hospitals’ ability to learn from alleged events. Furthermore, contrary to its policy, CMS informed the Joint Commission of few complaints, impeding the Joint Commission’s oversight of its accredited hospitals. We also found that hospitals investigated most alleged adverse events in our sample and that they found State agency responses valuable but disruptive. Hospital corrective actions resulted largely in training coupled with policy and process changes.

We recommend that CMS

  1. Require that all IJ complaint surveys evaluate compliance with the QAPI CoP,
  2. Ensure that State agencies monitor hospitals’ corrective actions for sustained improvements,
  3. Amend guidance on disclosure to explain the nature of complaints to hospitals, and
  4. Improve communication with accreditors.

CMS concurred with our recommendations.

After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries

October 20, 2011 Comments off

After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries (PDF)
Source: Robert Wood Johnson Foundation

This is the first national report to look at how effectively communities and hospitals coordinate care for some of their sickest patients—those leaving the hospital after a stay to treat an acute or chronic illness. Without high-quality care coordination, patients can bounce from home to the emergency room and back into the hospital, sometimes repeatedly. Hospital readmission rates are increasingly seen as markers of local health care systems’ ability to coordinate care for patients across the full continuum of care settings: hospitals, rehabilitation and skilled nursing facilities, nursing homes, clinician offices, hospice and home. Better care coordination promises to reduce readmission rates and improve patients’ lives while reducing costs. Improving care coordination for patients is also important to Medicare and to hospitals.

Medicare patients returning to the hospital shortly after they are discharged impose an enormous cost to Medicare that could be avoided with better post-discharge care. In its patient safety and quality initiative, the Centers for Medicare and Medicaid Services has estimated the cost of avoidable readmissions at more than $17 billion a year. Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1% of their total Medicare billings if an excessive number of patients are readmitted in fiscal 2012. The penalty rises to 2% in 2014 and 3% in 2015.

This Dartmouth Atlas report reveals striking variation in 30-day readmission rates across hospital referral regions and academic medical centers. Little progress was seen in reducing readmission rates over the five-year period 2004 to 2009. In fact, for some conditions, readmission rates have increased for the nation and for many regions and hospitals.

New From the GAO

October 17, 2011 Comments off

New GAO Reports (PDFs)
Source: Government Accountability Office

1.  Federal Chief Information Officers:  Opportunities Exist to Improve Role in Information Technology Management.  GAO-11-634, September 15.
Highlights -

2.  Long-Term Care Hospitals:  CMS Oversight Is Limited and Should Be Strengthened.  GAO-11-810, September 15.
Highlights -

3.  Temporary Assistance For Needy Families:  HHS Needs to Improve Guidance and Monitoring of Tribal Programs.  GAO-11-758, September 15.
Highlights -

4.  Evolved Expendable Launch Vehicle:  DOD Needs to Ensure New Acquisition Strategy Is Based on Sufficient Information.  GAO-11-641, September 15.
Highlights -

5.  Yucca Mountain:  Information on Alternative Uses of the Site and Related Challenges.  GAO-11-847, September 16.
Highlights -

U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates

September 29, 2011 Comments off

U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates
Source: Robert Wood Johnson Foundation

As scorekeeping begins for new Medicare penalties for hospitals with excessive numbers of patients returning shortly after they are discharged, a new Dartmouth Atlas Project report shows little progress over a five-year period in reducing these hospital readmissions and improving care coordination for Medicare patients. On the contrary, readmission rates for some conditions have increased nationally and for many regions and hospitals, including some of America’s most elite academic medical centers. The report shows that roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition.

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking variation in 30-day readmission rates across regions and academic medical centers. Researchers also found that more than half of Medicare patients discharged home do not see a primary care clinician within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

+ After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries (PDF)
+ Care About Your Care: Tips for Patients When They Leave the Hospital (PDF)
+ Lessons Learned in Performance Measurement: A Community’s Approach to Reducing Readmissions (PDF)


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