Thursday, December 15, 2011

TJC Issues Call to Action to Prevent Healthcare Worker Fatigue

The link between health care worker fatigue and adverse events is well documented, prompting The Joint Commission (TJC) to issue a new Sentinel Event Alert: Health care worker fatigue and patient safety.

The Alert urges greater attention to preventing fatigue among health care workers and suggests specific actions for health care organizations to mitigate the risks. An article in the November 2007 issue of The Joint Commission Journal on Quality and Patient Safety reported that nurses who work more than 12-hour shifts and residents working recurrent 24-hour shifts were involved in three times more fatigue-related preventable adverse events. In addition, health care professionals who work long hours are at greater risk of injuring themselves on the job.

“Health care is a round-the-clock job, and safety has to be the priority,” says Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., president, The Joint Commission. “The recommendations in this Alert give health care organizations the strategies to help mitigate the risks of fatigue that result from extended work hours – and, thereby, reduce the likelihood that fatigue will contribute to preventable patient harm."

The Alert addresses the effects and risks of an extended work day and of cumulative days of extended work hours. The Joint Commission Alert recommends that health care organizations:
- Assess fatigue-related risks such as off-shift hours, consecutive shift work and staffing levels.
- Examine processes when patients are handed off or transitioned from one caregiver to another, a time of risk that is compounded by fatigue.
- Seek staff input on how to design work schedules that minimize the potential for fatigue and provide opportunities for staff to express concerns about fatigue.
- Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue such as engaging in conversation, physical activity, strategic caffeine consumption and short naps.
- Educate staff about good sleep habits and the effects of fatigue on patient safety.

The Joint Commission also suggests that health care organizations encourage teamwork as a strategy to support staff who work extended work shifts or hours. For example, use a system of independent second checks for critical tasks or complex patients. Also, organizations should consider fatigue as a potentially contributing factor when reviewing all adverse events, and educate employees on the importance of good sleep habits, including ensuring their rest environment is conducive to sleeping.

The warning about health care worker fatigue is part of a series of Alerts issued by the Joint Commission. Previous Alerts have addressed diagnostic imaging risks, violence in health care facilities, maternal deaths, health care technology, anticoagulants, wrong-site surgery, medication mix-ups, health care-associated infections, and patient suicides, among others.

Source: TJC News Release

Partnership for Patients Initiative to Improve Hospital Care

Hospitals across the country will have new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from healthcare acquired conditions, the U.S. Department of Health and Human Services (HHS) announced. As a part of the Partnership for Patients initiative, a nationwide public-private collaboration to improve the quality, safety, and affordability of health care for all Americans, $218 million will go to 26 state, regional, national, or hospital system organizations.

Source: HHS News Release

New Data Indicates Affordable Care Act Provision Has Given 2.5m Young Adults Health Insurance

The National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) released data illustrating that the Affordable Care Act continues to significantly increase the number of young adults who have health insurance.

Because of the health care law, young adults can stay on their parents' insurance plans through age 26. This policy took effect in September 2010. Data from the National Health Interview Survey (NHIS) shows that since September 2010, the percentage of adults aged 19-25 covered by a private health insurance plan increased significantly, with approximately 2.5 million more young adults with insurance coverage compared to the number of young adults who would have been insured without the law.

“Thanks to the Affordable Care Act, 2.5 million more young adults don’t have to live with the fear and uncertainty of going without health insurance,” said Secretary Kathleen Sebelius. “Moms and dads around the country can breathe a little easier knowing their children are covered.”

The numbers show a continuation of the coverage gains due to the health care law as students graduate from high school and college in May and June and otherwise would have lost coverage.

The data is consistent with estimates from surveys released earlier in the year. Those surveys have shown an increase in the number and percentage of young adults 19 to 25 with health insurance coverage. Specifically, the Census Bureau and the Gallup-Healthways Well-Being Index Survey, as well as the NHIS release of data through March 2011, reported similar trends through early 2011.

The results, highlighted in an HHS issue brief, show that the initial gains from the health care law have continued to grow.

“The data announced today show that, because of the health care law, there is a continued and consistent pattern of improved health coverage among young adults,” said Sherry Glied, Ph.D., HHS assistant secretary for planning and evaluation. “The Affordable Care Act has helped literally millions of young adults get the health insurance they need so they can begin their careers with the peace of mind that they’re covered.”

For more information about this announcement, please see the HHS Issue Brief at

For more information about the CDC NHIS data released today, please visit

Source: HHS News Release

Tuesday, December 13, 2011

Health Care Fraud Crackdown Recovers $2.9b

Vice President Joe Biden, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) are teaming up to crack down on fraud. HHS and DOJ recovered $2.9 billion in health care fraud in 2011. HHS also announced it was taking more steps to prevent Medicare prescription drug fraud.

Source: HHS News Release

AHRQ Releases Medication Reconciliation Toolkit

The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services (HHS) released a new toolkit to help hospitals improve their medication reconciliation processes to reduce adverse drug events.

The Medications at Transitions and Clinical Handoffs (MATCH) Toolkit provides step-by-step instructions on how to improve a medication reconciliation process, from planning—including how to get leadership support—to pilot testing, implementation, and evaluation. Included is a workbook that helps users implement the Toolkit. The Toolkit is available at:

Source: AHRQ News Release

CMS Issues Rule on Availability of Medicare Data for Performance Measurement

Consumers and employers will have the health care information they need to make more informed choices about their care, thanks to the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule.

The rule gives qualified organizations, like employers and consumer groups, access to data that can help them identify high quality health care providers or create online tools to help consumers make educated health care choices. Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.
“This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs,” said Marilyn Tavenner, Acting CMS Administrator. “This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

For years, employers, consumers, and health care quality advocates have expressed frustration about the limited and piecemeal availability of Medicare data that could be used to help evaluate health care provider or supplier performance. Although many health plans have created provider and supplier performance reports, these reports are based solely on the health plans' own claims, and do not reflect information from other health plans, including Medicare.

Providers, too, have expressed frustration at receiving performance reports that are piecemeal and produced without an opportunity for review and correction. This final rule creates a framework for providers to receive a single, actionable performance report covering all or most of their practice.

The final rule makes a number of important changes from the original proposed rule. The final rule makes this data less costly for qualified entities, gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers, and extends the time period for health care providers to confidentially review and appeal performance reports before they become public. The rule also includes strict privacy and security requirements to protect patients, health care providers, and suppliers as well as stringent penalties for any misuse of Medicare data.

Click here for more information on the final rule.

The final rule on Availability of Medicare Data for Performance Measurement may be viewed here:

Source: CMS News Release

Thursday, December 8, 2011

Webcast of ONC Annual Meeting Available

The Office of the National Coordinator for Health Information Technology (ONC) held its 2011 ONC Grantee and Stakeholder Summit on November 17, 2011.

An archived webcast of this event is now available at:

Key speakers included:
Aneesh Chopra, United States Chief Technology Officer, Office of Science and Technology Policy, Executive Office of the President
Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology
David Blumenthal, MD, Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School
Leon Rodriguez, Director, HHS Office for Civil Rights
Rick Gilfillan, MD, Acting Director, Center for Medicare & Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services
Jay Walker, Curator, TEDMED Conference

Source: ONC News Release

Wednesday, December 7, 2011

Obama Administration Takes New Steps to Encourage Doctors, Hospitals to Adopt HIT

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years. HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs. The new administrative actions announced today, which were made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs. Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs. For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration’s work to create a nationwide network of 62 Regional Extension Centers. The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released, a new Centers for Disease Control and Prevention (CDC) survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs. EHR incentive payments for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program. The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent).

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce. The training is provided through 82 community colleges and nine universities nationwide. As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology. Currently there are 10,065 students enrolled in the training programs across the nation. As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the health care system, health IT can help keep information private and secure. Federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, and for a fact sheet about today’s announcement, visit

For more information about the Medicare and Medicaid EHR Incentive Programs, see

For more information on the 2011 CDC survey data referenced above, see

For more information about the HHS Recovery Act health IT programs, see

Source: HHS News Release

Monday, December 5, 2011

CMS Issues Final Medical Loss Ratio Rule

The Centers for Medicare & Medicaid Services (CMS) issued a final regulation that will ensure health insurance companies spend at least 80 percent of consumers’ health insurance premiums on medical care, not income, overhead and marketing. Insurance companies that fail to meet the new standard are required to provide a rebate to consumers.

Known as the Medical Loss Ratio (MLR), this rule provides unprecedented transparency and accountability of health insurance companies for customers. Created by the Affordable Care Act, the MLR requirements provide protection and value to approximately 74.8 million insured Americans. Estimates from last year indicate that, starting in 2012, up to nine million Americans could receive rebates worth from $0.6 to $1.4 billion. However, early reports suggest insurers lowered premium growth rather than face the prospect of providing rebates – a win-win for consumers.

“Under the Affordable Care Act, consumers are already seeing better value from their health insurance companies,” said CMS Acting Administrator Marilyn Tavenner. “If your insurance company doesn’t spend enough of your premium dollars on medical care or quality improvement this year, they’ll have to give you rebates next year. This will bring costs down and give insurance companies the incentive to focus on what matters for patients – high quality health care.”

MLR rules took effect on January 1, 2011 but the final rule makes modifications and provides certainty to how the MLR is calculated. These modifications are based on public comments solicited in an earlier version of the rule published by CMS in the spring.

The modifications made in the new rule:
- Make the MLR rebate tax free: Rather than having insurers send checks that could be taxed, workers in group health plans can receive rebates in a way that is not taxable.
- Increase transparency: Consistent with comments from consumer groups, the new regulation proposes that all consumers receive a notice, showing not just the amount of any rebate, but what the insurer’s MLR means regardless of whether there is a rebate, and how the insurer’s MLR has improved under the new law. In addition, data on the special types of plans, mini-meds and ex-patriate plans, will be publicly posted in the Spring.
- Keep strong policies on how MLR is calculated: The final rule makes only a minor change to a quality improvement definition to promote insurer improvements in defining or coding of medical conditions for a limited window of time.
- Phase down the special circumstances adjustment for mini-med plans: In 2011, so-called mini-med plans received a special circumstances adjustment to their MLR in the form of a multiplier of 2.0 for 2011. The final rule phases it down from 1.75 in 2012 to 1.5 in 2013 to 1.25 in 2014. Mini-med plans will be banned by the prohibition on annual limits in the Affordable Care Act starting in 2014.
- Recognize circumstances of special types of plans: The final rule, after reviewing data, keeps the ex-patriate plan multiplier adjustment at 2.0 due to their unique structure. It also levels the playing field between non-profit and for-profit insurers in states with premium taxes.

For more information on the final rule, visit:

Source: CMS News Release

Timeline for Health Care Reform

According to a recently published timeline for the implementation of the Affordable Care Act (health care reform), in 2012, Affordable Care Organizations will be voluntarily formed by health care providers to assume care for groups of 5000 or more Medicare patients.

The goal of the initiative is to lower the cost of health care without sacrificing quality.

Source: Article in Times Free Press

Thursday, December 1, 2011

Study: E-prescribing Is Safe, Efficient, but Barriers Remain

Physician practices and pharmacies generally view electronic prescribing as an important tool to improve patient safety and save time, but both groups face barriers to realizing the technology's full benefit, according to a study funded by the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ). The study is published online in the Journal of the American Medical Informatics Association.

Electronic prescribing, or e-prescribing, has multiple potential benefits, including helping to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. The study focused on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed.

Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. However, prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists—particularly drug name, dosage form, quantity, and patient instructions—continue to pose problems.

"Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, M.D. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."

Researchers at the Center for Studying Health System Change, Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies.

Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.

Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.

The study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to federal incentives. Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40 percent of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances, as part of the HITECH Act of 2009.

The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," concludes that a broad group of public and private stakeholders will need to work together to address these issues. Stakeholders include the federal government, e-prescribing standard-setting organizations, vendors and others. It is available at

Source: AHRQ News Release