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:

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:

King v Burwell: Supreme Court upholds Affordable Care Act

The Washington Post provided this overview of the Supreme Court ruling in King v. Burwell.

In considering the health-care law, the justices were asked to interpret a passage that said the tax credits are authorized for those who buy insurance on marketplaces that are “established by the state.”

But federal exchanges were authorized for states that did not set up their own, and the Obama administration argued that millions of people served by a federal marketplace were entitled to the subsidies, too.

The court agreed that that was the only way the law would work and that, although the legislation’s wording was problematic, Congress’s intent was clear.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter,” Roberts wrote.

Joining the chief justice in the majority were Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan. Opposing the decision were Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr.

Find the entire article by Robert Barnes here:

A brief analysis of the votes reads:

In the 6-to-3 decision, Chief Justice John G. Roberts Jr. delivered a sympathetic affirmation of what has become known as Obamacare, and his legal reasoning seemed to insulate the 2010 law against the legion of opponents who want to undermine the program before it takes hold in American life.

Kennedy’s position in the majority was particularly significant. In 2012, he was one of four justices who would have found the entire law unconstitutional.

Scalia said Roberts, who wrote the decision in 2012 that saved the Affordable Care Act from that challenge, has performed “somersaults of statutory interpretation” to preserve the law.

“We should start calling this law SCOTUScare,” he said. The comment drew laughter as Scalia emphasized his disagreement with the decision by reading part of his dissent from the bench.

The two cases, Scalia said, “will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

Chief Justice John Roberts wrote for the majority.  Here is the Post analysis:

There seemed to be a different tone to Roberts’s opinion this time. In 2012, he distanced the court from the legislation, writing, “It is not our job to protect the people from the consequences of their political choices.”

But in Thursday’s opinion, the language was more sympathetic. The complicated program “grew out of a long history of failed health insurance reform,” Roberts noted. He added that it was designed “to ensure that anyone who wanted to buy health insurance could do so.”

He acknowledged the disjointed way the law was written. It “contains more than a few examples of inartful drafting. . . . Congress wrote key parts of the act behind closed doors, rather than through the traditional legislative process,” Roberts wrote.

But rather than simply focusing on the phrase “established by the state,” Roberts said the court had to look at the intent of the entire law.

“The statutory scheme compels us to reject petitioners’ interpretation because it would destabilize the individual insurance market in any state with a federal exchange, and likely create the very ‘death spirals’ that Congress designed the act to avoid,” Roberts wrote.

He rejected the challengers’ argument that Congress intended to give the states an incentive to create their own exchanges.

To agree, Roberts said, would require rewriting the statute. “The states likely would have created their own exchanges in the absence of the IRS rule, which eliminated any incentive that the states had to do so.”

Some legal experts had thought the court might find the law ambiguous and thus simply uphold the Internal Revenue Service rule that said those who buy insurance on the federal exchange are entitled to the subsidies, in the form of tax credits, just as those who buy on a state exchange are. The court’s precedents call for deference to an agency when the law is unclear.

But crucially, Roberts said this was not a decision for an agency to make. He said the court needed to look at the law as a whole and concluded that even though the legislation’s language might be murky, its intent was clear.

Find the opinion here:

Monday, June 22, 2015

Hospital ERs charging for non-emergency visits

This from in Oklahoma City: OU Medical Center ER to charge fee for non-emergency visits (

Thank you for a NAHAM member for sharing this!  What do you think?  Will this have ramifications for patient access? 
The report reads as follows –
Doctors will decide if you are there for a real emergency. If not you can stay and pay or leave. O.U. Med has found it cares for 50,000 people each year in the emergency room. Forty percent of which do not actually require emergency care, causing overcrowding and O.U. Med to implement a new program.
The report tells of an emergency room incident twelve years ago when a mother of four children had a seizure while driving. She died on impact and the four children where rushed to the hospital. One son had to be taken to OU Medical Center in Oklahoma City but that ER was overcrowded so his son was flown to Tulsa.  That left the father scrambling: Four children in three locations. OU Med, officials hope they've found the cure to problems like this.
"Our ER needs to spend time with our high risk, real emergency patients and not with the low risk non-emergency patients," said Dr. Steinhart with OU Medical System.  OU Chief Medical Officer Dr. Curt Steinhart insures OU's new screening program.  "Fully compliant to federal law and no risk to patients," said Dr. Steinhart.
Under the new program, patients will enter the ER and go through a screening. If it's a true emergency, the patient stays. If not, there will be a copay or out-of-pocket charge of $200.  "An amount that will focus on them really deciding do they need to be seen here and now," said Dr. Steinhart.
If the patient doesn't want to pay, then OU Med will provide a list of nearby urgent care clinics.
"Not only is the ER the wrong place for these patients but it's not as good as care and it's more expensive," said Dr. Steinhart.
O.U. Med is not the first hospital in the nation to use this program, which has drawn some criticism from advocates stating in a published report, "this strategy could discourage patients from going to the ER for true emergencies."
Here is a list of when you should go to the Emergency Room according to OU Medical Center:
Here are warning signs of a medical emergency, according to the American College of Emergency Room Physicians (ACEP) and OU Medical Center.
  • Chest pain or upper abdominal pain that lasts at least two minutes
  • Uncontrolled bleeding
  • Sudden or severe pain
  • Coughing or vomiting blood
  • Difficulty breathing, shortness of breath
  • Sudden dizziness, weakness, or change in vision
  • Severe or persistent vomiting or diarrhea
  • Change in mental status such as confusion
  • Difficulty speaking
  • Unusual abdominal pain
  • Suicidal or homicidal thoughts
  • Changes in vision
  • Fever or flu-like symptoms (a patient may have severe flu and require hospitalization)
  • Allergic reactions (some are severe and may be life-threatening)
  • Broken bones
  • Animal bites (these can be significant in some cases)
Here is the list of when you should go to Urgent Care:
An urgent care facility is a doctor-staffed, walk-in medical facility that offers an alternative when there isn't an emergency and you don't have access to your personal doctor. It is generally more expensive than seeing your own physician but less expensive than an emergency room visit. The center usually has immediate access to simple laboratory procedures. OU Medical Center recommends an urgent care facility visit for:
  • A sprained ankle
  • Ear infections
  • Minor burns or injuries
  • Coughs, colds, sore throats
When to call you doctor (primary care physician)
  • If you think a person needs emergency treatment at a hospital, it's sometimes helpful to first call your doctor for advice. Do this only if you have the time and the doctor is immediately available. If not, then you should call 911 or go to the nearest hospital. Your doctor can advise you as to whether an emergency situation actually exists. 
  • If there is time to spare, then you should see your doctor first. Remember, a doctor's visit won't be as expensive as a hospital's emergency treatment. And it won't tie up vital emergency medical services. The doctor may also decide that the condition can be treated in his or her office or at home. This saves your time and the hospital's time, and reduces overall health care costs. 
Please note: nothing in this blog is intended to be medical advise from NAHAM News.