Tuesday, August 18, 2015

Hospital wait times, noise levels and other information posted online through Yelp

See the Washington Post article: "You can now look up ER wait times, hospital noise levels and nursing home fines on Yelp" by Lena Sun (August 5, 2015).

The article reports on the emphasis being put on healthcare services by Yelp, with the help of ProPublica, a nonprofit news organization based in New York.

ProPublica compiled the information from its own research and the Centers for Medicare and Medicaid Services. The data is for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics in the United States, and it will be updated quarterly.

What's the big deal?  According to the article: "Much of the information about hospitals, for example, is available on Medicare's Hospital Compare Web page. But Yelp executives say the information is sometimes difficult to find and hard to sift through."

This data will be in addition to the Yelp star rating system based on consumer reviews: "Consumers have always been able to review medical businesses using Yelp's star-rating system. Those ratings will continue to be based on consumer reviews. What's different now is the additional data that will pop up."

How are hospitals reacting?  Let us know your thoughts.

See the Washington Post article: "How hospitals hope to boost ratings on Yelp, HealthGrades, ZocDoc and Vitals" by Lena Sun (June 3, 2015).

See how one "reputations manager" is addressing the online data, "after several months of reviewing comments in real time on nearly a dozen Web sites, including Healthgrades.com, ZocDoc.com and Google Plus, as well as Facebook and Twitter".

So to answer the question What's the big deal? consider this point about expectations:

"But putting hospitals and doctors into the online rating world is fraught with possible problems. For one, patients and doctors have widely differing expectations."

"When patients are asked to rate how doctor quality should be measured, clinical outcomes, such as getting cured of a disease, rarely come up, said Lisa Suennen, who advises health-care companies. Patients talk about whether a doctor or nurse was kind to them, or whether their experience was fast and convenient. It’s assumed that the doctor is going to treat their illness or condition."

"Physicians, on the other hand, go straight to the clinical. The cancer is gone. Or the person can walk again. They don’t even talk about the other stuff, Suennen said. The two groups “are really disconnected.”

Consider this: The healthcare system featured in the Washington Post article reported about two negative reviews a day. (A score of 3 or lower, out of 5). Some days there would be none. Then there was a week with seven negative reviews, all for doctors who hadn’t been rated before.

"One scored 1.9 out of 5 because the patient waited more than 45 minutes and had only a few minutes with the doctor. Another review complained about a rude receptionist. Most negative ratings have to do with wait times and scheduling."

The article discussed how a system may push out positive comments and how the Cleveland Clinic has developed its own rating system in addition to the patient satisfaction survey required by Medicare.

"Even the Cleveland Clinic, one of the country’s most prominent medical centers, felt the digital pressure. It rolled out its own doctor rating site in April for more than 1,550 doctors. Responses are drawn from a patient satisfaction survey required by Medicare, which many hospitals use internally to target areas for improvement."

"Unlike some sites that rely on one or two reviews, Cleveland Clinic displays only ratings for doctors who have been reviewed by at least 30 patients. Ratings — one to five stars — are updated weekly and include negative as well as positive comments."

And consider this strategy of creating 37 categories, including office staff and bedside manner. “If someone writes that ‘Dr. Smith seems very smart but he only spent 3 minutes with me,’ ” the doctor scores a 5 for competency but maybe 3 on beside manner.

Monday, August 3, 2015

Notice Act presented to President - written notice to be required for observation status of more than 24 hours

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, introduced as H.R. 876 on February 11 of this year, made a quick run through the legislative process, having passed the House on March 16 after committee consideration and passing the Senate on July 27.  It is now waiting the President's signature. This action follows close on the heels of the CMS proposed changes to the two-midnight rule.

Becker's Hospital Review posted "9 things to know about the Notice Act on July 29".  Follow the link to the original article written by Erin Marshall.  The text follows:

1. The legislation calls for hospitals to provide written notice to patients who are in the hospital under observation status for more than 24 hours. Hospitals would need to provide notification no later than 36 hours after the time observation status begins.

2. The written notice must include why the patient was not admitted to the hospital and the financial implications of observation status, including subsequent eligibility for coverage for a skilled nursing facility.

3. Medicare does not cover skilled nursing facility stays unless the patient was admitted as an inpatient for a minimum of three nights. In some cases, physicians reclassify people as inpatients when more than observation is needed. Medicare patients who are not reclassified have to either forgo SNF care or pay for it themselves, regardless of the length of their hospitalization.

4. Medicare Part A pays for inpatient stays. If you are hospitalized on observation status, payment by Medicare is under Part B, which covers physician and outpatient services. Patients without Part B coverage are often left with the bill for observation status, even though there was not a perceptible difference in the type or level of care they received in the hospital.

5. If the NOTICE Act is signed into law by President Obama, hospitals across the nation will have to comply within 12 months.

6. A number of states, including Connecticut, Maryland, New York, Pennsylvania and Virginia, already require hospitals to give patients notice about observation care.

7. There were an estimated 1.5 million observation stays among Medicare beneficiaries in 2012. The number of observation stays increased 100 percent from 2001 to 2009, likely because of financial pressure on hospitals to reduce potentially preventable readmissions of inpatients within 30 days.

8. Under the NOTICE Act, hospitals would be required to notify patients about observation status, but patients can only change that status by swaying a physician or the hospital to do so. Yale-New Haven (Conn.) Hospital CEO Marna Borgstrom noticed that after learning they were under observation care, many patients left the hospital against medical advice.

9. The NOTICE Act is separate from CMS' two-midnight rule, for which it recently proposed updates as part of the 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed payment rule.

Thursday, July 23, 2015

What's In a Name for Newborns?

HealthDay News reported on naming conventions for newborns: What's In a Name? For Newborns, Maybe Fewer Medical Errors.  The "byline: "Using more specific names for newborns may reduce hospital mix-ups by roughly a third.

Here is the article in full, with sources identified below.

MONDAY, July 13, 2015 (HealthDay News) -- Using more specific names for newborns may reduce hospital mix-ups by roughly a third, a new study suggests.

Hospitals usually identify newborns by generic names such as "Babygirl Jackson" or "Brendasboy Jones" instead of the names parents give them. The reason: A patient record and name tag must be created immediately after birth, and changing records during a single hospital stay can cause confusion, said study lead author Dr. Jason Adelman, a public safety officer in the Montefiore Health System in New York City.

Since some parents haven't settled on a name when the baby is born, it's more efficient to use a standardized procedure for all, Adelman said.

In a previous study he conducted with 339 newborn intensive care units (NICUs) across the country, Adelman found that nearly 82 percent of them used indistinct names, such as "Babygirl Jackson" and "Babyboy Jones." The other 18 percent of hospitals incorporated some version of the mother's name, such as "Wendysgirl Jackson" and "Brendasboy Jones."

"We were able to demonstrate what everyone sort of knew but couldn't prove -- that using a generic naming convention increases the risk of wrong-patient errors, such as placing orders on the wrong patient," Adelman said.

Common errors seen with nonspecific first names can include reading imaging tests or lab specimens for the wrong patient, giving blood products to the wrong patient or giving a mother's expressed breast-milk to the wrong patient, explained Dr. Sheryl Ross, an ob-gyn at Providence Saint John's Health Center in Santa Monica, Calif.

"Improving patient safety is a top priority in health care and an added benefit is if it can be achieved in a cost-effective manner," Ross said. "Human error is one of the main reasons mistakes happen to patients in a hospital setting."

The study appeared online July 13 and will be published in the August print issue of the journal Pediatrics.

About 11 percent of medical errors are the result of patient misidentification, according to previous research described in this study.

"Many people knew that using only Babygirl or Babyboy was a problem, but they couldn't really report it because people don't like to report errors," Adelman said. "We came up with a way to track them."

His team used a tool that looks for all hospital orders that are placed and retracted within 10 minutes, and then placed on another patient by the same clinician within the next 10 minutes. Most of these are caught within a minute and never get carried out for the wrong patient.

The researchers tracked these errors for one year at the two NICUs of Montefiore Medical Center, Bronx, N.Y. During this time, the NICUs used the generic "Babygirl Jones" type of naming.

Then the hospital adopted the more specific "Catherinesgirl Jones" version. For twins and triplets, the new procedures used numbers at the start of the name, such as "1Sallysgirl Franklin" and "2Sallysgirl Franklin." The researchers tracked the errors for another year.

Errors dropped by 36 percent following the change. After accounting for multiple orders made at once, the researchers calculated that the new naming reduced errors by a third.

"The potential medical error that can occur when physicians or other health care professionals confuse one patient for another can be quite serious, even deadly," said Dr. Clay Jones, a pediatrician specializing in newborns at Newton-Wellesley Hospital in Massachusetts. "Imagine giving a medication meant for one patient to another patient with a life-threatening allergy to it."

Yet Jones said he is skeptical that this issue is a huge problem in NICUs, because of special alerts incorporated into patients' identifying labels. He nevertheless found the study intriguing and the issue worth exploring.

"The results of the study are impressive if simply looking at the percent decrease in retract-and-reorder errors," Jones said. "But we can't draw any firm conclusions."

He pointed out another possible explanation for the drop in errors that the authors also mentioned -- that clinicians were less likely to make mistakes because they knew why infant naming procedures changed and that errors were being tracked.

"It is entirely possible that the decrease in errors only happened because people were being more careful under the eye of the study researchers," Jones said.

Adelman said another drawback to this study is researchers cannot track the errors that actually make it to the patient. "We can only rely on reporting, and the evidence shows that doctors only report 1 percent of the errors they make," he said.

Still, he hopes this study will prompt more hospitals to change their procedures.

"Now that there's strong evidence that this really makes a difference, I'm hoping this will accelerate the adoption of using these more distinct names," Adelman said. "That's the best news for parents out there."

More information

For more about procedures in the NICU, visit the C.S. Mott Children's Hospital at the University of Michigan.

SOURCES: Jason Adelman, M.D., M.S., patient safety officer, Montefiore Health System, New York City; Sherry Ross, M.D., ob/gyn and women's health expert, Providence Saint John's Health Center, Santa Monica, Calif.; Clay Jones, M.D., neonatal hospitalist, Newton-Wellesley Hospital, Newton, Mass.; July 13, 2015, Pediatrics, online

Copyright © 2015 HealthDay. All rights reserved.

New Portal from The Joint Commission focusing on the physical environment

The Joint Commission and the American  Society for Healthcare Engineering (ASHE) launched a new Physical Environment Portal July 14 to provide online resources and tools for hospitals to be compliant with the eight most challenging Joint Commission Life Safety (LS) and Environment of Care (EC) standards.

The portal is available to the public and includes resources for both facility managers and leadership. For Joint Commission-accredited organizations, there also is an enhanced feature that includes actual surveyor comments and other resources.
Over the next 16 months, the portal will highlight the eight LS and EC standards cited most frequently by The Joint Commission for noncompliance. Each standard will be highlighted in modules that are scheduled to be released in two parts; the first part to be released one month, and the second part to be released the following month. The first part of the module supports facilities managers by focusing on what the requirements are and what compliance should be. In the second part, a new component focuses on resources for leadership and the clinical team to assist in evaluating the organization’s level of compliance. A new module is to be posted every two months, with the previous ones remaining on the site.
The portal is housed on The Joint Commission website, with links to module-specific information on the ASHE site. There also will be solutions presented by Joint Commission Resources. Information will be offered in a variety of formats, including articles, videos and infographics.

Tuesday, July 7, 2015

24/7 Online Consultations

HealthData Management reports Cleveland Clinic Offers 24/7 Online Urgent Care

Patients in Ohio can access an online urgent care consultation around the clock.

With its MyCare Online service, available to anyone in Ohio, Cleveland Clinic is the first hospital in Ohio to offer such consultations.

American Well is providing the technology platform and the board-certified medical professionals.

The service is priced at $49 per consultation.

The hospital’s goal is to integrate its providers into the service.

Some Cleveland Clinic physicians have already begun using MyCare Online for “virtual appointments” with their patients following surgery.

MyCare Online can be accessed from a free app called Cleveland Clinic MyCare, downloaded from Google Play, Apple’s App Store, or on the web.

Service is provided through a private and secure video telemedicine consultation

As reported: Providers will be able to judge the seriousness of a rash, an earache or flu-like symptoms and diagnose and possibly treat many other acute health symptoms including cough, urinary tract infection, abdominal pain, diarrhea, fever and headaches.  If necessary, providers will be able to send an electronic prescription to a patient’s pharmacy.

Compare this online consultation approach to providing healthcare with a more applications focused service.  USA Today reports in The digital doctor is in: Next wave in healthcare that the "health care industry is in the midst of a technological boom".

Tuesday, June 30, 2015

Supreme Court to consider who owns healthcare claims data

Modern Healthcare reports that The U.S. Supreme Court will hear a case next term on whether a self-funded insurer should have to turn over certain information to the state of Vermont.

The Court announced Monday, June 29, that it would hear Gobeille v. Liberty Mutual Insurance Co. The Supreme Court's new term will begin in October. The case will likely be heard in November or December.

FInd the article, Who controls the data? US Supreme Court agrees to hear healthcare case, by Lisa Schencker here:  http://www.modernhealthcare.com/article/20150629/NEWS/150629889?utm_source=modernhealthcare&utm_medium=email&utm_content=externalURL&utm_campaign=am

In the case, the state of Vermont argues it needs certain data from Liberty, such as claims, member eligibility and other issues, to help it improve the cost and effectiveness of healthcare.

Liberty Mutual, however, argues that the federal Employer Retirement Income Security Act, known as ERISA, protects it and its third-party administrator from having to hand over the information, which is otherwise required by the state. 

The 2nd U.S. Circuit Court of Appeals already ruled that ERISA, which regulates traditional pensions and other employer-provided benefits, takes precedence over state law, meaning Liberty Mutual's third-party administrator shouldn't have to turn over the data. 

But the US Solicitor General's office, representing the federal government, argues the case has national consequences:

“With the encouragement of the federal government, other states are establishing similar healthcare databases to help improve health outcomes for their citizens, and thus the question presented has national importance.”

“If States are unable to acquire such data from self-insured ERISA healthcare plans, their databases will be significantly less comprehensive and thus not as useful in developing health policy at both the state and national levels.”

The state of Vermont argues that it needs access to such data to to create consumer-oriented websites, conduct research on healthcare outcomes or track access to specialists.

“As healthcare costs continue to skyrocket and place enormous pressures on state budgets, the States have an urgent need to take advantage of the 'great potential' … offered by all-payer claims databases.”

Liberty Mutual argues that ERISA pre-empts state law regarding the collection of data: 

“In addition to protecting the interests of beneficiaries, Congress intended to protect plans and employers with self-funded plans (and, ultimately, employees and beneficiaries as well) from the burdens of complying with conflicting state laws by reserving the field of employee benefit plans for federal regulation.”

Monday, June 29, 2015

What next for Affordable Care Act?

The Kaiser Health News identifies the next 5 hurdles the ACA must clear -

Medicaid Expansion. About 4 million more Americans would gain coverage if all states expand the state-federal Medicaid programs to cover people with incomes at or slightly above the poverty line. Twenty-one states with Republican governors or GOP-controlled legislatures, including Texas and Florida, have balked, citing ideological objections, their own budget pressures, as well as skepticism about Washington’s long-term commitment to pay for most of the costs.Spacer

Anemic Enrollment. Eighteen million Americans who are eligible to buy insurance in federal and state marketplaces haven’t purchased it. Those marketplaces have had particular trouble enrolling Hispanics, young adults and people who object to being told to buy insurance.  Federal funding used by state marketplaces to enroll people and advertise is drying up. Many state marketplaces haven’t figured out how to be self-sustaining. Vermont, Hawaii, Colorado and Rhode Island are among those states searching for more money. The penalty for going without coverage rises next year to $695 per adult or 2.5 percent of family income—whichever is larger.Spacer

Market Stability. Nationally, premiums haven’t gone up too much on average in the first two years of the marketplaces, but that could change. The federal government has been protecting insurers from unexpectedly high medical bills, but that cushion disappears after next year. At the same time, insurers finally have enough experience with their initial customers to figure out if their premiums are sufficient to cover medical costs. If they’re not, expect increases.Spacer

Affordability. People who get their insurance through their employer have mostly been spared jolts from the health law. But the federal government begins taxing expensive health plans in 2018. The “Cadillac tax,” created by the health law, will pressure employers to offer skimpier health coverage or pass the taxes’ cost on to their employees. Also, individuals buying their insurance on the health law marketplaces continue to risk large out-of-pocket costs if they need lots of care. Their maximum financial obligations for next year are $6,850 for individuals and $13,700 for families. Those who choose to go out of their insurance network may have no ceiling on how much they may have to pay.Spacer

Political Resistance. The Supreme Court's ruling did little to diminish the GOP’s zeal to repeal the health law. Republicans on both sides of the Capitol pledged to continue their efforts to kill the ACA. A lawsuit filed by House Republicans last year alleges the president overstepped his authority when implementing the health law. The topic remains grist for the 2016 presidential campaign, with several Republican presidential candidates – including Sen. Lindsey Graham, R-S.C., and former Florida Gov. Jeb Bush — reiterating their desire to repeal the law. If the Republicans capture both the White House and Congress in 2016, all bets are off over whether the law survives intact.

Kaiser Health News writers Julie Appleby, Mary Agnes Carey, Phil Galewitz and Jordan Rau contributed to this report.  Find the article here: http://khn.org/news/five-hurdles-ahead-for-obamacare/