These statistics are from the Redspin research report “Breach Report 2011: Protected Health Information.”

Of course certain things like encrypting data on all mobile devices is a necessity at any hospital nowadays. You’d be surprised, however, how many facilities don’t do it.

This problem is just going to get worse with employees bringing their smartphones, iPads, etc. to work.

In fact, 39% of all PHI breaches to date are from laptops or other portable devices. They’re the easiest things for thieves to steal and, even more likely, employees to loose. And — here’s the shocking part — 50% of respondents in a recent healthcare IT poll say their facilities aren’t doing anything to protect data on those devices.

Some options for securing PHI aren’t that expensive, but options that provide top of the line security are obviously more expensive.

For example, the Boyd Company estimates that healthcare data security spending in 2012 will go over $40 billion. That’s a 22% increase from 2011 levels. And it’ll top $70 billion by 2015.

The Boyd Company created an analysis of the costs of operating a healthcare data security center in U.S. cities. The analysis looked at the cost of skilled labor in health information and data security; land costs; construction costs; taxes; utilities; corporate travel and other occupancy costs.

The annual costs in the study were based on centers occupying 150,000 sq. ft of newly constructed space, and employing 150 workers.

It found that some cities are most cost effective for operating a healthcare data security center than others.

Top 3 most expensive locales

1. New York
2. San Francisco
3. Los Angeles

Top 3 lowest cost locales

1. Sioux Falls, SD
2. Tulsa, OK
3. Ft. Walton/Destin, FL

For more information about the Boyd Company report, “Healthcare Services Industry: A  Comparative Cost Analysis for Information Assurance Operations,” click here.

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Unfortunately, the answer may be no, according to a study published in The Journal of Pediatrics.

The study makes it appear that insurance coverage may play a vital role in the care children get.

Researchers from Children’s Hospital Boston found:

• compared to children with private insurance, those with public insurance (Medicaid or CHIP) or no insurance were 22% less likely to be tested or have a procedure when they went to the emergency room, and
• children who didn’t have insurance were less likely to receive any medication than those with public or private insurance.

However, these findings didn’t hold true for children diagnosed with a significant illness.

The study was based on an analysis of emergency department (ED) visits recorded in the National Hospital Ambulatory Medical Care Survey from 1999-2008. It’s based on approximately 33,000 annual visits.

So what’s the reason for the treatment disparity?

The study authors gave some possible explanations for it:

First, children with private insurance are 11 times more likely than children without insurance or with public insurance to have a primary care physician (PCP). Therefore, when children with insurance go to the emergency room (ER) they are usually referred there by their PCP with instructions from the PCP for a specific workup, including extra tests and procedures.

Secondly, children with PCPs are less likely to go to the ER for non-emergency care.

Finally, parents who don’t have insurance or their children have public insurance are more worried about money and request fewer tests and treatments.

So are ERs skimping on care to uninsured and publicly insured kids because private insurance pays more so those kids get more attention?

It’s highly unlikely. The clinicians that work in the ER don’t know whether a child has private insurance, Medicaid or no insurance.

What do you think is the behind the treatment disparity in these patient populations? Share your opinions in the comments area below.

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While healthcare coupons may offer discounts on items and services reimbursable by the federal healthcare program, there are a lot of stipulations that have to be taken into consideration.

To help keep providers and facilities safe so they don’t break any laws, like those of the Federal anti-kickback statute, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued an advisory opinion (No. 12-02) with the following guidelines:

• Coupons may only offer discount services, not free services. And providers must give the same discount to any third-party payor or insurance carrier that the provider offers to the patient. For example, a provider may not offer a 20% discount directed only at the patient’s cost-sharing amount. The website must include information explaining that the coupons apply to the entire service, and the coupons themselves must include similar language.
• The website offering the coupon can’t be that of a provider. It would have to be a third-party marketer that charges providers a flat fee to host the coupons. Any marketing done by a healthcare provider of any type would be subject to extra scrutiny. Reason: The OIG says “healthcare providers and suppliers are in a position of trust and may exert undue influence when recommending healthcare-related items or services.”
• Coupon use can’t be relied on by providers. The OIG states that providers and advertisers would pay a set fee, consistent with fair market value to purchase the space for posting their coupons on the website. And the fee wouldn’t take into account the volume or value of any business garnered by the coupon. For example, providers would be able to see statistics regarding how many times their profile was viewed and how many times customers downloaded their coupon, but the fee charged wouldn’t vary based on these statistics.
• Personal information about the coupon purchaser can’t be shared with the provider. In other words, an account can’t be a requirement to download the coupon, and any personal information provided, such as an email address, can’t be shared with the provider.
• The coupon has to be structured like the ones people get through snail mail. To decrease the risk of violating the anti-kickback statute, the customer can’t pay anything up-front for the coupon. Prepayment of a coupon increases the likelihood of service over-utilization. The example the OIG gave was, if a person bought a prepaid coupon for service x, when that person walks into the offering provider’s office requesting service x — having already paid for service x — the offering provider might feel pressure to render it even if it isn’t medically necessary.
• Providers must comply with the discount safe harbor. Under the arrangement, providers would be the “sellers” and the customers would be the “buyers” for purposes of the discount safe harbor.  To qualify for protection under the discount safe harbor, buyers and sellers have certain reporting obligations to ensure that any discounts are shared with federal healthcare programs.

What do you think about providers offering service coupons — good idea or just too risky? Share your thoughts below.

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Rosen pleased guilty to participating in a scheme which involved former state Sen. Carl Kruger (D-Brooklyn), Assemblyman William Boyland Jr., (D-Brooklyn) and the late Assemblyman Anthony Seminerio (D-Richmond Hill). The scheme funneled hundreds of thousands of dollars to the politicians in return for using their influence in Albany to benefit Rosen’s healthcare organization.

At Rosen’s request, he was tried before a judge rather than a jury. After a three-week trial last year, Judge Jed Rakoff found him guilty.

His lawyer, Elkan Abramowitz, argued that Rosen did what he had to do to secure the survival of his hospitals — which served New York’s poor — and that he didn’t ask for any of the money for himself. He also asked the judge to let Rosen off on probation and community service.

The courts probation office recommended a sentence of 10 years.

The NYDailyNews reported that Judge Rakoff said that while he had no doubt Rosen was “a good man in many respects,”  the seriousness of the crimes required him to send Rosen to prison. Rakoff added this case was tragic because it showed how someone who had been widely admired and sought to better the health care of poor communities used his position to bribe state legislators.

After serving three years in prison, Rosen will also spend two years under supervised release and is required to pay a $500 special assessment fee.

Rosen maintains his innocence. That’s why Abramowitz told the judge he would be filing an expeditious appeal on Rosen’s behalf.

Kruger resigned and pleaded guilty to corruption charges in December and was sentenced to seven years in prison. Boyland was acquitted, but later arrested on new bribery charges. Seminerio, plead guilty to an earlier case of fraud and died in prison.

What’s your opinion on this case? Share your thoughts in the comments section below.

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With initial symptoms reflecting those of the common influenza virus or forms of pneumonia, a diagnosis for Legionnaires takes more extensive testing, allowing symptoms to worsen and more people to be exposed.

This dangerous strain of bacteria spreads through infected water or aerosols in areas where there’s poor air ventilation.

The worst outbreak in history exposed the bacterium to nearly 16,000 people before it was contained, and in other cases, death rates reached into the double digits.

Take a look at the 12 worst Legionnaires’ outbreaks in the world, listed in chronological order:

1. Philadelphia, PA, USA |  1976
Source: Air conditioning
Death-to-infection rate: 34/221, or 15.4%
Fact: This was the first recorded outbreak of the disease, and the mysterious strain of bacteria that caused it was finally identified. 

 2. Stafford, England | 1985
Source: Hospital air conditioning unit
Death-to-infection rate: 28/175, or 16%
Fact: This marked the largest outbreak of Legionnaires disease in Britain.

3. Bovenkarspel, Netherlands | 1999
Source: Hot tub
Death-to-infection rate: 32/318, or 10%.
Fact: More deaths from this bacteria could have been recorded, but bodies had already been buried before they had identified Legionnaires as the cause of the outbreak.

4. Melbourne, Australia | 2000
Source: Cooling tower at a newly opened aquarium
Death-to-infection rate:  4/95, or 4.2%
Fact: 100% of those diagnosed with the disease had visited or passed within 500 m of the the Melbourne Aquarium in the same 4 week period, allowing scientists to pinpoint the exact source of exposure.

5. Murcia, Spain | 2001
Source: Hospital air conditioning
Death-to-infection rate: 6/100, or 1%
Fact: This is the world’s largest outbreak of the disease, where at least 16,000 people were exposed to the bacterium.

6. Barrow-in-Furness, England | 2002
Source: Contaminated cooling tower in a neighborhood arts center
Death-to-infection rate: 7/172, or 4%
Fact: The Barrow Borough Council and the architect of the arts center were charged with, but cleared of, corporate manslaughter charges, and were later fined for breaches of health and safety regulations.

7. Lens, France | 2004
Source: Cooling tower at a petrochemical plant
Death-to-infection rate: 7/59, or 11.8%
Fact: This marked the worst Legionnaires outbreak ever recorded in France.

8. Zaragoza, Spain | 2004
Source: Hospital cooling tower
Death-to-infection rate: 7/27, or 26%
Fact: Five of the seven victims of this outbreak were above the age of fifty.

9. Fredrikstad, Norway | 2005
Source: Air scrubber of a nearby factory
Death-to-infection rate: 10/56, or 17.8%
Fact: The patients that became ill in this outbreak lived over 20 km apart, but the high velocity, large drift and high humidity in the air scrubber were linked to the long-distance spread.

10. New Brunswick, NJ, USA | 2008
Source: Contaminated supply of drinking water
Death-to-infection rate: 2/6,  or 33%
Fact: Exposure to patients in the hospital where the outbreak occurred has been traced back to a sudden drop in chlorine levels in the hospital’s drinking water.

11. Dayton, OH, USA | 2011
Source: Hospital air conditioning
Death-to-infection rate: 5/11, or 45%
Fact: This was the largest outbreak of Legionnaires’ disease in Ohio since 1994.

12. Calpe, Spain | 2012
Source: Currently unknown
Death-to-infection rate: 3/18, or 17%
Fact: The infection quickly spread through a beach hotel and claimed the lives of three British vacationers before being contained.

http://www.legionellacontrol.com

http://www.hcinfo.com/

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Just how much of a risk do they pose?

To find out the answer to this question, Symantec, a provider of security, storage and system management solutions, lost 50 smartphones … on purpose. The phones were left in very public places in five major cities. And the devices were loaded with simulated corporate and personal data, as well as software that allowed the company to monitor phone use.

Here’s what was discovered:

• 96% of the phones were turned on by their finders
• Nearly half of the finders tried to access the phone owner’s bank account
• 60% of the finders tried to view social media info and email
• 80% of finders tried to access corporate info including files marked as human resource salaries, human resource cases and other corporate info, and
• 50% of the people who found the phones tried to return them.

So if your hospital uses mobile devices, what can you do to protect the data on them?

• Develop and enforce security policies for employees using mobile devices for work. For example, all mobile devices must have password-enabled screen locks.
• Don’t just focus on securing the device. The patient data on the phone must also be protected no matter where it’s exchanged.
• If a mobile device is lost, have a formal process in place so everyone knows what to do.
• Integrate mobile device security and management into the overall facility security and management, and
• Take inventory of the mobile devices connecting to your hospitals  network.

Simply having a password on the phone and the ability to remotely wipe data off the phone, could have prevented most of the problems that arose in the Symantec study.

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As an academic medical center and the safety net for the St. Louis region, Barnes-Jewish Hospital sees any and all kinds of patients and conditions — making its drive for excellence especially tough.

After all, if you specialize in a few things, it’s easier to excel at them because you have a limited focus. Trying to be the best at everything, is a lot more difficult. So the hospital took on one issue at a time.

Step 1

The first step in achieving its goals was to employ “lean management.” This management system was designed to minimize waste, standardize processes and drive continuous improvement.

Standardizing patient care was key. While Barnes-Jewish Hospital standardized its processes for patient care, it allowed tailored intervention per individual patient — when appropriate. This “variation” was allowed because it benefits patients by providing care specific to their needs.

Step 2

The next step involved training the facility’s future providers. The hospital requires residents to have four hours of lean training and then they have to participate in a process improvement project.

One of these projects was for central line-associated blood stream infections (CLABSIs). Previously, the hospital’s seven intensive care units (ICUs) each had its own method for reducing CLABSI. Under the lean system, all ICUs standardized their practices in insertion, maintenance and follow-up.

For example, the clinicians who insert central lines were trained in a simulation to use evidence-based, standard practices, such as being required to wear a gown, gloves and have a sterile field.

The nurses, who maintained the catheters, had a standardized schedule for changing dressings and the hubcaps of the line.

And finally, the clinicians were trained to question the patient’s need for continued use of a central line on a daily basis using a standard checklist.

Thanks to this process improvement project, the hospital experienced a dramatic drop in CLABSIs.

Other projects tackled at the facility included: diabetes medication errors, pressure ulcers and transition of care. To read more about these click here.

Has your facility implemented any quality improvement projects? If so, tell us about them in the space provided below.

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Transcatheter aortic valve replacement (TAVR), which allows doctors to replace a patient’s aortic valve through a small opening in the leg, is less invasive and gives patients who normally can’t undergo open heart surgery a fighting chance at survival.

The announcement of the coverage decision on May 1, is one of the first under a mutual memorandum between CMS and the FDA to get new, lifesaving technology to patients sooner.

To offer this procedure to patients, certain provider, facility and data collection criteria have to be met. Reason: It’s still a fairly new technology, and CMS and the FDA want to make sure these procedures are done by highly trained professionals in facilities that are well equipped so patients receive the safest and best care possible.

That’s why the decision states the procedure is covered under “Coverage with Evidence Development.”

The procedure will be covered for the treatment of symptomatic aortic-valve stenosis when the following five conditions — each of which has its own criteria — are met:

• The procedure is performed with a complete aortic valve and implantation system that has received FDA pre-market approval for that system’s FDA approved indication.
• Two cardiac surgeons have independently examined the patient’s suitability for open aortic valve-replacement surgery.
• The patient is under the care of a heart team: a cohesive, multidisciplinary team of medical professionals.
• The heart team’s interventional cardiologists and cardiac surgeons must jointly participate in the intraoperative technical aspects of TAVR, and
• The treating team and hospital must participate in a national registry that enrolls TAVR patients and tracks the following outcomes: stroke; all-cause mortality; transient ischemic attack; major vascular events; acute kidney injury; repeat aortic valve procedures; and quality of life.

TAVR is covered for uses that aren’t listed as an FDA-approved indication, but only when done within a clinical study that meets required conditions.

For the complete list of all the conditions, click here.

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Having positive physician/nurse relationships.

The best hospitals have their docs and nurses working hand in hand. It’s a relationship among peers: Both professions share in getting patients well, and delivering the best healthcare experience possible.

Here are two best practices Dr. Jonathan Burroughs, a certified physician executive, and president and CEO of The Burroughs Healthcare Consulting Network, has uncovered through his experience working in the hospital setting:

1. Nurse-Physician Councils — It’s a group of nurse and physician leaders, who meet with a specific purpose — to improve and optimize nurse/physician relationships and communication. They address nurse/physician issues such as:

• trust and respect
• communication, which entails consistent use of Situation, Background, Assessment, Recommendation (SBAR)  and other patient safety tools to optimize clinical effectiveness
• protocols that help to coordinate schedules so physician and nurses work together
• clinical and functional pathways to identify when they’re obligated to respond to each others needs and concerns, and
• bad behaviors.

The council addressed issue of mutual concern that affected patient safety, staff morale, turnover and frustrations.

2. Nurse-Physician Dyads — Nurses and physicians need to lead together if they are going to work effectively. In this best practice, a nurse and physician manager lead their clinical units together through all phases of operations, including:

• oversight of physician and nursing performance
• establishment of clinical and functional protocols and evidence-based practices
• oversight of the operation plan and budget
• supply chain management and inventory
• peer review and performance improvement activities, and
• modeling an effective collaborative culture.

This requires both professions to re-examine their roles and co-manage. For some it means taking on greater responsibilities, for others it entails listening and being more open to different opinions. It’s not easy, but it’s well worth it in the end.

What best practices has your facility implemented to advance nurse/physician relationships? Share your practices in the comments section below.

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Thanks to the skilled medical professionals who perform these surgeries, along with advanced medical technologies, mortality rates and complications have been significantly reduced. But despite ongoing medical advancements, there are still procedures that present high risk for complications during the procedure or recovery period.

Here’s a list of the 10 riskiest medical procedures:

10. Bariatric surgeries/Gastric yypass

As with many other major surgeries, there are risks that patients take when electing to undergo them, but these patients’ excessive weight poses even more threats. Surgeons have a harder time operating and must use special instruments because internal organs are often hard to separate and have may layers of slippery fat surrounding them. These patients also have an increased risk for complications with anesthesia, because it’s often difficult to insert the tube into their airways, and drugs or anesthetic gases may need to be given in higher dosages because they are easily absorbed by fat. Breathing must also be closely monitored before, during and after the surgery, as these patients have a higher risk of developing of pneumonia.

9. Septal Myotomy

This surgical procedure is performed to reduce the thickening of the heart muscles, a symptom of patients diagnosed with advanced stages of a complex type of heart disease called hypertrophic cardiomyopathy (HCM). This is a complicated procedure because it requires the patient to be placed on cardiopulminary bypass, or the “heart-lung machine”, so that the surgeon can work on a still heart. In total, this surgery can last anywhere from 3 to 6 hours, and the recovery period requires a stay in the Intensive Care Unit.

8. Pancreatectomy

This procedure comes along with a fairly high risk of complications. In fact, a Johns Hopkins study documented complications in 41% of pancreatectomy cases. These include serious problems like post-operative bleeding, delayed gastric emptying — a condition in which food and liquids are slow to leave the stomach — internal anastomatic leaking. The good news is that in recent years, the mortality rate for this procedure has decreased to a range of 5-10%.

7. Thoracic Aortic Dissection Repair

Aortic dissection, or a tear in the innermost layer of the heart, can trigger a number of high-risk complications like heart failure, stroke or even a rupture of the aorta, making its repair vital to the survival of the patient. Immediate treatment is required and this often results in the surgeon removing the area of dissected aorta and rebuilding the blood vessel with a synthetic graft.

6. Esophagectomy

This is a major surgery which carries a lot of risk because of the reconstruction of the area between the stomach and the healthy part of the esophagus. Three different methods of this surgery can be performed depending on the patient’s condition, but they all carry with them serious risks, such as a leakage of the fluid from the stomach or esophagus where the new connection was made. Despite the risks, most patients recover well and have few complications.

5. Bladder Cystectomy

This procedure is most often performed to remove a part of, or the entire urinary bladder, in patients diagnosed with bladder cancer. The major risks for this procedure are the highest for an infection of the intestine which can lead to peritonitis or the inflammation of the membrane lining the abdomen. For procedures that remove only a part of the bladder, there is a high risk for urine leakage from the bladder incision site, which can cause a number of other internal problems.

4. Coronary Revascularization

Also known as coronary artery bypass grafting (CABG), this procedure reroutes the blood around one or more clogged coronary arteries to help improve blood flow to the heart. New connections are made using arteries or vein grafts taken from another part of the patient’s body. For some patients whose ventricular function is failing too quickly, this surgery may not be an option because the risks are too high.

3. Spinal Osteomyelitis Surgery

There are a number of treatments that patients may undergo before requiring surgery to correct this spinal infection, but for those with spinal instability, significant deformity and/or neurological deficit, a paravertebral abscess causing sepsis, or any sized epidural abscess, emergency surgery is often needed. Infections of the spine are extremely destructive, and any surgical procedures performed on this area comes with a lot of risk, such as complete or partial paralysis, or other serious infections.

2. Surgical Ventricular Restoration

This procedure is done to treat congestive heart failure as a result of a heart attack in order to improve its function by restoring it to its normal size and shape. This, like any other heart-related surgery, is very risky because the patient is put on the heart-lung machine and major repairs are done to a very sensitive part of the body. Improvements in techniques have been made and the hospital readmission rate for a SVR is only 8.8%.

1. Craniectomy

Any type of brain surgery presents a high risk to the patient because the brain controls every function in the body. But a craniectomy presents even more risks. This procedure requires that the piece of skull removed to access the brain is not replaced after the surgery is complete, leaving fully recovered patients the risk of brain damage after the surgery if they do not properly protect their head. Depending on the area of the brain where this procedure will be performed, other serious risks like changes or loss in the functions of vision, mobility, speech, memory, coordination, and more can be permanent. Excessive build up of fluid in the brain, stroke, seizures, spinal fluid leakage, swelling of the brain, and more can also occur after the procedure, making this one of the highest risk surgeries.

Sources: surgery.com
mayoclinic.com
clevelandclinic.org
hopkinsmedicine.org

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