New Initiative Targets Hospital Errors, Readmissions
On April 12, Health and Human Services Secretary Kathleen Sebelius announced the creation of a national public–private initiative aimed at reducing the number of preventable injuries and complications in patient care over the next three years—potentially saving some 60,000 lives and up to $35 billion in health care costs. Two of the goals of Partnership for Patients are to decrease preventable hospital-acquired conditions by 40 percent over three years ending in 2013 and to reduce all hospital readmissions by 20 percent over the same period.
The partnership, which has already attracted support from 500 organizations, seeks to focus hospitals, medical professional associations, employers, and consumer groups on preventing adverse drug reactions, pressure ulcers, childbirth complications, surgical site infections, and other safety problems for which there are evidence-based prevention strategies. The federal government will make $1 billion available to promote such innovations, funds that were allocated through the Affordable Care Act.
This announcement comes on the heels of a new study, published in the April 11 issue of Health Affairs, that found one of three patients will encounter some type of medical error during a hospital stay—a much higher number than previously estimated. Most efforts to detect medical errors rely on voluntary reporting and the use of the Agency for Healthcare Research and Quality's Patient Safety Indicators. The new study compared these two methods against the Institute for Healthcare Improvement's Global Trigger Tool, which relies on careful review of patient charts to identify "triggers," such as medication stop orders or abnormal lab results, that may point to an adverse event. When used to examine the same set of medical records from three different hospitals, the three methods produced dramatically different results: voluntary reporting detected four problems, the Patient Safety Indicators found 35 problems, and the global trigger tool detected 354 events.
Hospital Compare Adds Data on Hospital-Acquired Conditions
Early this month, the Centers for Medicare and Medicaid Services (CMS) added data on the number of hospital-acquired conditions occurring at hospitals across the country to its Web site, Hospital Compare. The eight conditions being tracked are:
- foreign object retained after surgery;
- air embolism;
- blood incompatibility;
- pressure ulcer stages III and IV;
- falls and trauma;
- vascular catheter–associated infection;
- catheter-associated urinary tract infection; and
- manifestations of poor glycemic control.
The data show the number of such conditions at each hospital per 1,000 discharges for Medicare fee-for-service patients between October 2008 and June 2010. They are not adjusted to account for the mix of patients being treated. The conditions were selected because they result in high costs to Medicare and/or occur frequently during hospital stays. Evidence suggests that such conditions can typically be prevented by following evidence-based care guidelines.
Large Medical Groups Launch Data-Sharing Project
On April 6, five large medical groups—Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare, and Group Health Cooperative—launched the Care Connectivity Consortium to securely exchange electronic health information on their patients. While there are already several initiatives designed to share such information using local and regional electronic exchanges, this effort is much larger in scale and involves sharing data on millions of patients across several states.
The number of patients who will seek care from more than one of these providers—thus necessitating exchange of their medical records—is likely to be small, because there is little geographic overlap in their systems. Still, the privacy and security standards used for the data exchange and the solutions to creating an interoperable platform across each system's existing electronic health records will provide an important model for others working to create health information exchanges. Eventually, the consortium hopes to attract other provider organizations to expand its reach and demonstrate the concrete improvements in health care quality that can result from the timely distribution of clinical information across providers.
Proposed Rules on ACOs Released
On March 31, CMS released much-anticipated proposed rules for creating accountable care organizations (ACOs), a new type of provider group (involving hospitals, physician groups, nursing homes, and others involved in patient care) authorized under the Affordable Care Act. ACO participants, who are supposed to work together to manage care for a defined population of Medicare patients, stand to benefit from lowering overall health care costs while meeting performance standards. CMS is soliciting public comment on the proposed rules by June 6, after which a final rule will be promulgated. The ACO program will be launched on January 1, 2012.
The 492-page document provides guidelines on provider eligibility, legal requirements, governance requirements, leadership and management structure, applicants' plans to promote evidence-based care and engage patients, public reporting, and the shared savings payment methodology.