Twenty-six organizations received the honor of being the first granted with the Healthcare Innovation Awards. Check out what these groups did to win a total of $122.6 million.

Award winners were chosen for their:

• innovative solutions to the healthcare challenges facing their communities
• focus on creating a well-trained healthcare workforce equipped to meet the needs of the 21st century healthcare system, and
• money-saving practices.

The preliminary award winners are expected to reduce healthcare spending by $254 million over the next three years.

The projects, which receive funding for three years, include collaborations among the country’s leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations and patients’ advocacy groups.

“We can’t wait to support innovative projects that will save money and make our healthcare system stronger,” said Health and Human Services Secretary Kathleen Sebelius in a CMS press release. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower costs.”

This is only the first batch of award winners. More will be announced in early June 2012.

Here’s an overview of a few of the winning projects:

• Beth Israel Deaconess  Medical Center, Boston.  The facility is receiving $4,937,191 for its project “Preventing avoidable re-hospitalizations: Post-Acute Care Transition Program (PACT)”. It’s estimated that the project’s three-year savings will be $12.9 million. The goal of the project is to improve care and reduce hospital re-admissions for Medicare beneficiaries dually eligible for Medicare and Medicaid. These patients represent over 8,000 discharges for conditions such as congestive heart failure, acute myocardial infarction and pneumonia.

  By integrating care, improving patients’ transitions between locations of care, and focusing on a battery of evidence-based best practices, this model is expected to prevent complications and reduce preventable re-admissions. The results would be better quality health care at a lower cost in the urban Boston area.

• Pittsburgh Regional Health Initiative, Pittsburgh.The initiative is getting $10,419,511 for its project “Creating a virtual accountable care network for complex medical patients.” It’s estimated that the initiative’s three-year savings will total $74.1 million.

  The organization plans to create specialized support centers, staffed by nurse care managers and pharmacists, to help small primary care practices offer more integrated care within the service areas of seven regional hospitals in Western Pennsylvania.

  The resulting teams will provide support for care transitions, intensive chronic disease management, medication adherence, and other problems associated with a lack of communication in healthcare systems at large and the resulting fragmentation of health care for patients. This approach is expected to reduce 30-day re-admissions and avoidable disease-specific admissions.

• Regents of the University of California, Los Angeles.“UCLA Alzheimer’s and dementia care:  comprehensive, coordinated, patient-centered” project will be awarded $3,208,540, and it’s estimated three-year savings is $6.9 million.

  This award will expand a new program to provide coordinated, comprehensive patient- and family-centered care for 1,000 Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia. The goal is to reduce hospitalizations and shorten hospital stays, reduce emergency room visits, and improve patient health, caregiver health, and quality of care.

  The program will train and deploy professional and non-professional workers, and unpaid volunteers, expand a dementia registry, conduct patient needs assessments, and create individualized dementia care plans.

• University Hospitals of Cleveland, Ohio.The facilities are getting $12,774,935 for the project “Transforming pediatric ambulatory care: the physician extension team.” The estimated three-year savings will be $13.5 million. University Hospitals (UH) Rainbow Babies and Children’s Hospital at UH Case Medical Center award is for improving care for 65,000 children in Medicaid with high rates of ER visits, complex chronic conditions and significant behavioral health problems. The intervention will offer healthcare advice, referrals and coordinated services through telehealth and home nurse hotlines.

  It will also provide practice-tailored facilitation for primary care providers and financial incentives to physicians who reach quality performance targets, agree to offer extended hours and make themselves available to treat these kids.

For a complete list of award winners, click here.

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Should nurses be allowed to administer anesthesia without a doctor’s supervision?

This is a debate that’s been plaguing hospitals around the country. It started in 2001 with a change to Medicare and Medicaid regulations. The change allowed states to opt out of a requirement that nurse anesthetists be supervised.

Many believe this is a good change. Reason: It gives increased access to healthcare for people in rural areas who have to travel outside their local community to find a facility that has an anesthesiologist.

The two sides of the debate are:

• Nurse anesthetists, who specialize in administering anesthesia. Argument: They are highly capable of administering anesthesia without the supervision of a physician, because they learn about the same drugs, equipment and standards of care as physicians do.
• Anesthesiologists, who are physicians who specialize in administering anesthesia. Argument: Anesthesia is a complex and technically demanding area of medicine that requires the skill of a physician, or at least the supervision of a physician, in case complications arise.

Colorado is one of 17 states that have decided to allow nurse anesthetists to administer anesthesia without physician supervision. Due to this decision, the state finds itself embroiled in a legal battle.

In 2010, anesthesiologist and medical societies filed a lawsuit in state court. The lawsuit asserted that allowing nurse anesthetists to deliver anesthesia without supervision wasn’t consistent with state law — a requirement for opting out of the federal rule.

However, the lawsuit was dismissed. A judge ruled the legislature did intend for the practice to be allowed. But that didn’t stop the medical societies. They appealed the ruling last May. Nationally, both sides are keeping a close watch on this case.

Colorado isn’t alone. The California Society of Anesthesiologists petitioned the State Supreme Court to take another look at its 2009 lawsuit for opting out of the supervision requirement. Much to the chagrin of the California Hospital Association, the suit hasn’t been successful. The association is on the nurses side due to the difficulty it’s had staffing anesthesiologists in facilities in California’s rural areas.

Where does your facility stand on this debate? Share thoughts in the box below.

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From 2010 to 2011, data breaches increased 32% in hospitals and healthcare organizations, mainly because of two reasons: 

• The use of unsecured mobile devices to transmit data, and
• employee mistakes.

That’s according to the Second Annual Benchmark Study on Patient Privacy & Data Security by the Ponemon Institute. The study surveyed 72 healthcare organizations.

The rise in breaches is happening despite increased compliance with the HITECH Act and HIPAA. Unfortunately, a lot of hospitals and healthcare organizations feel a bit helpless because their security and privacy budgets aren’t sufficient to cover their expenses of training, technology, etc.

And as data breaches rise, so do the costs. This year, a compromised record cost an average of $214, while a data breach event averaged $7.2 million.

Some statistics from the study that’ll interest health executives include:

• 96% of the organization in the study had at least one data breach in the past 24 months, most of which were due to employee mistakes. On average, respondents had four data breach incidents in the past 24 month.
• 29% of respondents said in a one-year span of time, a data breach at their organizations led to identity theft.
• 81% of the facilities surveyed use mobile devices to collect, store and/or transmit some type of protected health information (PHI), and 49% of them admit these devices aren’t protected.
• The average number of lost/stolen records per breach was 2,575, and
• Only 29% of respondents said the prevention of unauthorized access and loss/theft of patient data is a priority, but 51% of respondents said they were very familiar with HIPAA/HITECH privacy, security and data breach notification laws and rules.

On the plus side, the study found healthcare organizations are making progress in their efforts to stop data breaches.

Thanks to the requirements of HIPAA and HITECH, facilities have better trained and more knowledgeable staff, as well as better policies in place. As a result, more data breaches are being discovered by employees and audits rather than patients. In fact, discovery of breaches by patients has dropped from 41% to 35%.

Do you feel your facility is on the cutting edge when it comes to policies and procedures in place to protect patients’ PHI? If so, share them in the comments box below.

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Looks like the Medicare Shared Savings Program, which offers financial incentives for hospitals, physicians and other healthcare providers to team up in Accountable Care Organizations  (ACOs), is starting to pick up speed.

Recently, 27 ACOs have entered into agreements with the Centers for Medicare & Medicaid Services (CMS), bringing the current total  to 65. The number of beneficiaries receiving care from providers participating in the program has grown to more than 1.1 million.

And CMS is currently reviewing more than 150 applications from ACOs looking to participate in the program in July.

So far, CMS has established 33 strict quality measures ACOs have to follow in order to provide appropriate, safe and timely care. These quality measures relate to:

• care coordination and patient safety
• appropriate use of preventive health services
• improved care for at-risk populations, and
• patient and caregiver experience of care.

Advocates of ACOs see them as a way to improve care to Medicare beneficiaries, while at the same time slowing the rising costs of healthcare by changing the incentives that influence how hospitals and physicians work.

As for patients, ACOs are designed to improve care, reduce costs and lift the frustration of disconnected care (i.e., lost medical charts among multiple providers, sharing the same info over and over again among different doctors, duplicate medical tests and procedures, etc.).

Initially, hospitals were expected to dominate ACOs. However, the majority of the 27 new ACOs are physician-led organizations.

So why aren’t more hospitals jumping on the ACO bandwagon?

It could be because starting an ACO isn’t something you can do over a lunch meeting. It’s a complex, expensive and time-consuming project that requires dedicated and skilled leadership.

Maybe other facilities are waiting to see whether the first ACOs can operate successfully.

More than likely, it’s a combination of both.

Industry experts believe even if the Affordable Care Act (ACA) is shot down, since the Medicare ACO program isn’t the controversial part of the law, it will be able to stand on its own. If it can’t stand on its own, CMS may turn the program into a demonstration project.

The point is, many experts believe ACOs are the model to be followed for the future whether the ACA gets the Supreme Court’s approval or not.

What’s your opinion? Are ACOs a viable solution to help facilities lower healthcare costs and increase quality of care? Share your opinion in the comments box below.

For more information on ACOs, click here.

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Pop quiz time: If an employee spots a medical error, what is he/she most likely to do?

1. Report it right away.
2. Keep it to him/herself.
3. It depends on the kind of policy your facility has on reporting safety/medical error incidents.

Of course, you’d hope the answer is A – that staff would drop everything and report it immediately. But for many facilities, the answer is C – it depends on your policy.

A recent study by the Agency for Healthcare Research and Quality (AHRQ), revealed many hospitals still are lagging behind in their open communication of medical errors. The study, which surveyed nearly 600,000 staffers at more than 1,110 hospitals nationwide, found:

• 54% said when an adverse event is reported, “it feels like the person is being written up, not the problem”
• nearly 50% of participants said they felt their mistakes were held against them, and
• almost 66% said they worried mistakes were being held in their personnel file.

The AHRQ did its first patient-safety culture report in 2007, and unfortunately, only about one-fifth of hospitals have improved their performance in the category of “non-punitive response to error,” — and 16% have gotten worse! The rest are struggling to make progress.

What hospital executives have to realize is the “carry a big stick” approach when it comes to staff making medical errors only places patients in more danger.

The American Medical Association supports non-punitive policies for reporting safety incidents. Your employees need to feel OK with admitting mistakes. They need to know that they won’t be punished – unless it’s an act intended to cause harm or noncompliance with safety protocols. But regular “oops” mistakes need to be looked into and learned from.

Yes, this is much easier to write than to do, but studies are showing that higher safety culture scores are correlated with better clinical outcomes and lower rates of hospital-acquired conditions.

Here are some articles from the AHRQ that can help you improve your safety practices:

• Safe practices for better health care
• Impact of working conditions on patient safety
• Patient safety tools: Improving safety at the point of care

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No one likes hospital stays. Unfortunately, they’re often necessary to help people recover from ailments. Problem is a new study found hospital stays actually may start a downward spiral in elderly patients’ cognitive ability.

The study, which was published in the journal Neurology, followed 1,870 seniors over the age of 65 for 12 years and periodically tested their cognitive ability. Of those patients, 71% were hospitalized at least once. And of those hospitalizations, 97% were for general medical issues.

Let’s face it, a lot of people do slow down as they get older. However, the study’s results showed that for the patients who were hospitalized for any length of stay, their cognitive decline was 2.4 times greater than before their hospitalization and compared to study participants who weren’t hospitalized.

Granted, the sicker and older patients were, led to a faster mental decline. But even after those factors were taken into account, the impact of hospitalization was still statistically significant.

Dr. Robert Wilson, the study’s director and neuropsychologist at Rush University Medical Center in Chicago, equated the rate of decline directly after a hospital stay to that of aging 10 years. “What we showed is that once you get out of the hospital your trajectory is downhill.”

So what’s the reason for such a dramatic decline?

Dr. Wilson theorizes that hospitalization is very common in the elderly, and as people age they struggle with their mental abilities and that people with mental issues may be hospitalized more often.

Other possibilities are:

• Impact of medications
• Complications  from surgery
• Sleep deprivation
• Switch to an unfamiliar environment, and
• Little to no exercise.

So what can be done to curb this decline in the hospitalized elderly population?

Experts suggest hospitals need to rethink how they care for this patient population by offering more opportunities for them to move/exercise even in small ways. And keeping their minds active with something other than TV, such as crossword puzzles, word searches, etc., and encouraging families to visit and engage their loved ones in conversation more.

Sure, that’s easier said than done, especially when hospitals are already doing more with less.

What do you think about the study and how hospitals can keep this patient population more active and engaged? Share your thoughts in the comments box below.

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A Texas nurse was sentenced to life in prison after being found guilty of killing five of her patients with bleach injections.

Kimberly Saenz, a former nurse at a dialysis clinic in Lufkin, Texas, was convicted on five capital murder charges. She was also sentenced to three 20-year terms for aggravated assault related to other patients who were injured in similar attacks.

Saenz’s attorney had argued during the trial that the deaths were the result of chronic problems with improper cleaning of equipment at the clinic, and that Saenz was being used as a scapegoat.

Jurors deliberated for 45 minutes before agreeing on a sentence. Saenz’s lawyer claimed that the jurors opted for a life sentence instead of the death penalty at least in part because prosecutors failed to show that she was at any risk of committing future violence. He pointed to the fact that she had “behaved” in the past four years since the deaths as evidence that she was not a threat.

Prosecutors had said earlier that they would seek the death penalty, but didn’t specifically call for it during the sentencing phase. However the prosecution did make a point of reminding jurors that she had a history of stealing drugs from previous employers and had faked the results of some of her employment drug tests.

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A nurse is accused of killing five of her patients by injecting bleach into their dialysis tubes. Kimberly Saenz is on trial for capital murder charges in the five deaths. Saenz pleaded not guilty. If she’s convicted, prosecutors have said they will seek the death penalty.

At the time of the deaths, Saenz had been working as an entry-level vocational nurse at DaVita Dialysis in Lufkin, Texas.

The charges were filed about a year after a local fire official wrote an anonymous letter to the state health department. In the April 2008 letter, the official raised a red flag over a series of suspicious incidents at the clinic which resulted in paramedics being called to the scene.

Among other things, the letter detailed a two-week period in which 16 patients had to be transported by ambulance from the clinic.

Within days, investigators were at the clinic — and discovered that paramedics had been called to the clinic 30 times that month. Nineteen people had to be transported to the hospital (seven of them with cardiac complaints) — and four people had died after treatment at the clinic. For reference, in the previous 15 months, ambulance crews had been called only twice.

On April 28, 2008, inspectors were on-site when two patients were stricken ill — and others said they had witnessed Saenz inject bleach into dialysis tubes being used by two patients. Saenz was sent home, the local police were called and the clinic was shut down. The two patients later died.

Subsequent investigation found traces of bleach in various equipment used to treat some of the patients who got sick or died. DaVita had used bleach in various concentrations to clean both internal machinery parts and chairs used by patients. Staffers were supposed to use reactive agents to confirm that any bleach residue had been removed and that the cleaned items were safe for patient use.

More details into the investigation are hard to come by — the court’s put a gag order on all parties involved. But Saenz’s lawyers have noted previously that their client has no criminal record and no apparent motive for trying to kill her patients. Her lawyers have suggested that the clinic was sloppy about its disinfectant procedures and that she’s being used as a scapegoated for systemic problems.

However, prosecutors paint Saenz’s history in less generous terms, noting a history of prescription painkiller abuse, addiction, and having been fired from four prior health care jobs. Prosecutors say she also lied on a more recent employment application, in violation of her bail agreement.

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Hospitals’ incident reporting systems are only registering about 14% of patient injuries, according to a new study. 

That’s the conclusion of a new statement from the Office of the Inspector General. According to the report, hospitals investigate the patient harm events that are most likely to help them make safety or quality improvements and they made relatively few policy changes based on the events that were reported.

As for the other 86% of incidents, hospitals said 61% were events that the staff didn’t perceive as a reportable event. The rest were normally reported but not reported in that specific instance.

OIG noted that all the hospitals reviewed had incident reporting systems in place and that hospital managers say they rely on the systems to monitor quality of care and catch potential problems.

Because incident reporting is so vital to hospitals, OIG recommended that CMS take the following steps:

• collaborate with the Agency for Healthcare Research and Quality (AHRQ) to create a list of potentially reportable incidents that hospitals could use
• provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events
• suggest that surveyors evaluate the information collected by hospitals using AHRQ’s Common Formats, and
• scrutinize survey standards for assessing hospital compliance with the requirement to track and analyze events and reinforce assessment of incident reporting systems as a key tool to improve event tracking.

To see the full report as a downloadable PDF click here.

Will those steps actually improve incident reporting and make it easier for hospitals to improve overall patient care? Share your thoughts in the comments.

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Social media has real business benefits within health care — and serious negatives that can be hard to protect against — whether or not you even use the sites.

The open nature of social media sites like Facebook and LinkedIn means that no matter how carefully you manage your own profile — or even if you choose not to use them — there are some things you simply can’t protect yourself from.

Take the case of Jerry Penner, the CEO of Murray-Calloway County Hospital in Murray, Kentucky.

Shortly after coming to the hospital, a hospital VP made a joke about Penner having sent a friend request to all of the VP’s staffers, but not the VP himself. The only problem? Penner hadn’t sent any of the requests.

A little sleuthing turned up a fake profile of Penner that used a photo of him from a hospital web page, and his basic biographical info such as his educational and work history, which were correct aside from a few mistaken dates. There were few posts made on the page, and aside from some poor grammar and spelling, none of the information posted was damaging or harassing to Penner — but he was understandably disturbed.

Penner said his privacy settings on the site are relatively high and he uses the page mostly to communicate with business connections and promote the hospital.

Activity on the fake profile died down until recently, when a flurry of Penner’s real-life friends and colleagues received friend requests from the fake profile. Most upsetting to Penner: One hospital employee received a friend request with an “I love you” note attached.

In that instance, the person was already connected to Penner on Facebook and knew there was an impostor afoot. But Penner has no ideas who else may have received such inappropriate messages, and if those people realize they aren’t coming from him.

Penner said he had received little assistance from Facebook about the fake account — while he can no longer see the page when he logs on, he said other friends of his can.

For medical professionals who are already leery of social media’s privacy pitfalls, this may seem like one more reason not to use it. But not having the ability to monitor what other people say about you (or say as you) on social networking sites can be even more damaging in the long run.

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