Surveying The News

Penalizing Hospitals For Being Unsafe: Why Adverse Events Are A Big Problem

A Kaiser Health News article published Sunday about upcoming hospital penalties included an analysis of Medicare data by Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. This week, Jha also wrote up his own take on the data. Originally posted on his Harvard blog, Dr. Jha’s copyrighted assessment is republished below, all rights reserved:

By Ashish K. Jha

Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally.  Indeed, as I have written before, patient safety is a major issue in American healthcare, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical mishaps, and so forth. As I wrote previously, according to Office of Inspector General (OIG), when an older American walks into a hospital, he or she has about a 1 in 4 chance of suffering some sort of injury during their stay.  Many of these are debilitating, life-threatening, or even fatal.  Things are not much better for younger Americans.

Given the magnitude of the problem, many of us have decried the surprising lack of attention and focus on this issue from policymakers.  Well, things are changing – and while some of that change is good, some of it worries me.  Congress, as part of the Affordable Care Act, required Centers for Medicare and Medicaid Services (CMS) to penalize hospitals that had high rates of “HACs” – Hospital Acquired Conditions.  CMS has done the best it can, putting together a combination of infections (as identified through clinical surveillance and reported to the CDC) and other complications (as identified through the Patient Safety Indicators, or PSIs).  PSIs are useful – they use algorithms to identify complications coded in the billing data that hospitals send to CMS.  However, there are three potential problems with PSIs:  hospitals vary in how hard they look for complications, they vary in how diligently they code complications, and finally, although PSIs are risk-adjusted, their risk-adjustment is not very good — and sicker patients generally have more complications.

So, HACs are imperfect — but the bottom line is, every metric is imperfect.  Are HACs particularly imperfect?  Are the problems with HACs worse than with other measures?  I think we have some reason to be concerned.

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June 25th, 2014, 12:19 PM by KHN Editors

Short Takes On News & Events

‘Right-To-Try’ Laws On Experimental Drugs Stir Debate

KHN’s Julie Rovner participated in a Google Hangout with PBS NewsHour on state “right-to-try” laws, first approved in Colorado, which allow terminally ill patients to try potentially life-saving, but unapproved drugs to treat their conditions. Watch the discussion below:

June 24th, 2014, 1:00 PM by KHN Editors

Short Takes On News & Events

Employer Health Costs Forecast To Accelerate In 2015

Health costs will accelerate next year, but changes in how people buy care will help keep them from attaining the speed of several years ago, PricewaterhouseCoopers says in a new report.

The prediction, based on interviews and modeling, splits the difference between hopes that costs will stay tame and fears that they’re off to the races after having been slow since the 2008 financial crisis.

“This is not an immediate return to double-digit growth rates,” says Ben Isgur, a director in PwC’s Health Research Institute. However, he adds, “what we’re seeing for 2015 will be our first uptick in some time.”

If health plans stay unchanged, PwC sees medical costs rising by 6.8 percent in 2015, up from a projected increase of 6.5 percent this year. (PwC defines medical costs as per-capita health expenses for private insurers and large, self-insured employers. This is different from the government’s measure of health spending, which includes outlays for the government programs Medicaid and Medicare.)

But PwC doesn’t expect plans to stay the same. In a separate study, the consulting firm forecasts that employers and insurers will continue to raise deductibles and give members other incentives to mind the price of care. (The deductible is what patients pay before insurance kicks in.)

Those changes should slow growth in the total cost of care to 4.8 percent, PwC says, as greater exposure to price tags prompts workers to undergo fewer treatments and tests. (PwC expects the deceleration from 6.8 percent to 4.8 percent to come solely from changes in consumer behavior, not money employers save by shifting costs to workers.)

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June 24th, 2014, 6:48 AM by Jay Hancock

Short Takes On News & Events

Talking Medicare’s Hospital Fines For Too Many Patient Injuries

KHN’s Jordan Rau was on NPR and C-SPAN Monday to talk about coming Medicare penalties for about a quarter of the nation’s hospitals as detailed in his story More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries.

The penalties will ding hospitals up to 1 percent of their Medicare pay for having higher rates of patient injuries. Watch the C-SPAN video interview and listen to the NPR audio of his conversation below:

June 23rd, 2014, 12:44 PM by KHN Editors

Short Takes On News & Events

Senators Offer Bill To Ease Readmission Penalties On Some Hospitals

A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions.

The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized. Over the past two years, the federal government has reduced payments to two-thirds of the nation’s hospitals because they have high numbers of patients becoming ill and returning after being discharged. This fall the program will put as much as 3 percent of a hospital’s Medicare payments at risk and it will expand the number of conditions it bases the assessment on — currently heart attack, heart failure or pneumonia – to include chronic obstructive pulmonary disease and total hip and knee replacement.

Medicare does adjust for different levels of sickness of patients among hospitals, but it has said the Affordable Care Act, which created the program, does not give regulators the leeway to take socio-economic status into account.

An advisory committee to Congress last year recommended that lawmakers change the program.  The idea of taking socio-economic status into account has also been endorsed in a draft report from  a panel created by the National Quality Forum, which is a nonprofit group that reviews quality measures for the government.

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June 19th, 2014, 3:56 PM by Jordan Rau

Health Care In The States

How Your State Rates In Terms Of Long-Term Care

This copyrighted story comes from ‘s Shots blog. All rights reserved.

In just 12 years, the oldest members of the huge baby-boom generation will turn 80. Many will need some kind of long-term care. A new study from AARP says that care could vary dramatically in cost and quality depending on where they live.

The study was motivated by a simple fact: The number of available family caregivers is declining. In 2010, there were potentially seven for each person 80 years old or older. By the time baby boomers reach that age, there will be only four potential caregivers for each of them. And those numbers are expected to continue declining. Chalk it up to longer lives and smaller families.

Susan Reinhard, a senior vice president at AARP, says the study can show states where they need to improve. “The gradual pace of improvement has to pick up,” she says. “We don’t have the time to get ready for the demographic imperative that is before us.”

The study looked at 26 different variables in each state, from affordability and access to whether care is delivered in private homes or more expensive nursing homes. Reinhard says states that encouraged more care at home got higher marks. “It’s a philosophy, it’s a value that states have and they work hard to make that happen,” she says.

AARP calls its study a scorecard. So, if you’re keeping score, the state with the highest marks was Minnesota, followed by Washington, Oregon, Colorado and Alaska. Bringing up the rear were Indiana, Tennessee, Mississippi and Alabama, with Kentucky coming in last.

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June 19th, 2014, 2:14 PM by Ina Jaffe, NPR News

Short Takes On News & Events

Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings

Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are “unethical” and the exams are more likely to do harm than good.

In recent years, more hospitals have paired with firms offering such testing packages, partly to build community goodwill and referrals.  Hospitals say residents benefit from the testing packages, which can cost less than $150, because some will discover they are at higher risk for heart problems or stroke early enough to take steps to reduce their risks.

But some medical groups and consumer advocates object to the programs, saying they are a waste of money for most consumers.

Public Citizen argues “the promotions rely on fear mongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses.”

It sent letters to hospitals in eight states, including Inova in the Washington, D.C. area, Scottsdale Healthcare in Arizona, Dignity Health in California and the University of Iowa Health Alliance, urging them to stop promoting such tests.

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June 19th, 2014, 12:24 PM by Julie Appleby

Health Care In The States

Future Uncertain For VA Rural Health Pilot Program

TOPEKA — Sen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even as major legislation moves through both houses of Congress that would have similar goals as the pilot program.

The pilot program is called Access Received Closer to Home, or ARCH. It’s offered at five sites — Pratt, Kansas; Caribou, Maine; Farmville, Virginia; Flagstaff, Arizona, and Billings and Anaconda, Montana. The program allows veterans to get health services from community providers if they live at least one hour from a VA health facility.

Five senators sent a letter to the VA secretary, asking why the program is ending. The letter reads, in part: “For reasons we do not understand, the Veterans Health Administration (VHA) is choosing — at VHA’s own initiative — to end this successful program despite the more than 90 percent satisfaction rate communicated by veterans. … All along, the VHA gave us the impression that they were waiting on analysis about the success of ARCH to inform their decision about extending the program — this is a misleading storyline at best. We are deeply disappointed by this breach of trust because those who suffer from this recklessness are veterans.”

In addition to Moran, the letter to Acting VA Secretary Sloan Gibson is signed by fellow Sens. Jon Tester, D-Mont., Angus King, I-Maine, Susan Collins, R-Maine, and John McCain, R-Ariz.

While VA officials have told members of Congress that no decision has been made on whether to let ARCH expire, Moran said veterans and VA employees in Kansas have told him that the national program director for ARCH directed the five pilot sites several months ago to begin contacting veterans who participate in ARCH to let them know the program would be ending. Moran suspects the VA is motivated by financial concerns.

“If they pay for services outside the VA, it’s less money that they’ve had to use within the VA, and of course the focus ought to be on the quality of service and the timely access to care that this kind of program can provide,” Moran said.

Moran said bipartisan legislation based on the ARCH program is moving through Congress, a response to the VA waiting times scandal. That legislation offers some veterans the opportunity to seek care outside of the VA system. It would cover some of the same services vets have been receiving under ARCH, but Moran and the other senators are concerned that ARCH vets could see a lapse in care if the VA doesn’t extend the pilot program. He’s calling on Gibson to halt plans to dismantle the program.

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June 19th, 2014, 5:00 AM by Bryan Thompson, Kansas Public Radio

Short Takes On News & Events

HHS Releases New Details About 2014 Marketplace Premiums, Subsidies

Federal officials on Wednesday released new data about who enrolled in the federal health marketplace plans for 2014, how much the law’s subsidies helped offset the cost and how many plans people from could choose from, among other details.

“What we’re finding is that the marketplace is working. Consumers have more choices and they’re paying less for their premiums,” newly installed Health and Human Services Secretary Sylvia Burwell said in a statement.

The report was one in a series of ongoing updates from HHS about enrollment in the online exchanges or marketplaces. Federal officials have said more than 8 million people signed up for coverage under the health law. The document analyzed trends in the 36 states where the federal government is running the online marketplace, or exchange. It did not include similar data for the 14 states and the District of Columbia that are running their own exchanges because the data is not available, according to the report.

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June 18th, 2014, 9:01 AM by Mary Agnes Carey

Short Takes On News & Events

Enroll America Pushes Ahead To Second Enrollment Period

Enroll America convened a national conference this week in Washington to review the strategies that proved successful during the inaugural Affordable Care Act open enrollment period and  to  gear up for the next one, which will start Nov. 15.

Organizers also want to ensure that the navigators and organizations working toward enrollment maintain their energy — despite reports of backlogged Medicaid applications and continuing struggles in some state-run exchanges.

“It’s energizing people and bringing them together and reminding them why they got into the work in the first place,” said Anne Filipic, president of Enroll America, a nonprofit group organized primarily to sign up consumers for new health coverage. “We’re five months out, so it’s time to be implementing and outreaching.”

Kentucky Gov. Steve Beshear, a Democrat, was among those at the conference Tuesday to offer a list of accomplishments. Kentucky, he said, enrolled 421,410 people in individual health coverage either via kynect, the state’s online insurance portal, or Medicaid.  Seventy-five percent of them had never had health care insurance before.

Beshear credits this public response to the decision to insulate kynect from the affiliation with the national health law The enrollment numbers suggest that worked. In Kentucky, traditionally considered a red state, 60 percent of voters supported Republican candidate Mitt Romney in 2012.

Looking forward, he also said that the re-election efforts of naysayer lawmakers — those who have worked so hard to discredit and disband the overhaul — will come down to how people with the new coverage experience the benefits of the law.

Meanwhile, former Health and Human Services Secretary Kathleen Sebelius told attendees that they were pivotal in making the first enrollment season successful. “You combated relentless misinformation and obstruction, people who were faced with getting fingerprinted and paying a fee in order to help access care,” Sebelius said.

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June 18th, 2014, 5:00 AM by Lisa Gillespie