Tag: Patient Safety

Medicare penalties begin taking toll

More than three dozen hospitals across the U.S. will be penalized more than 3% on most of their CMS reimbursements in 2015, the first year in which the agency’s three Medicare quality and safety incentive programs will be in effect.

According to a Modern Healthcare analysis of CMS data on penalties for fiscal 2015, when readmission, hospital-acquired condition and value-based purchasing rates are combined, two hospitals will have much of their Medicare payments docked over 4%. This includes a 4.44% reduction for the 180-bed Palisades Medical Center in North Bergen, N.J., and a 4.21% reduction for the 455-bed Pennsylvania Hospital in Philadelphia, one of the oldest hospitals in the U.S.

Dr. Patrick Brennan, chief medical officer and senior vice president at the University of Pennsylvania Health System, said Pennsylvania Hospital is addressing specific problems and expects to see improvements in fiscal 2016. The readmission penalty increased from 0.35% in 2014 to 3% in 2015 because of additional measures for hip and knee surgery being added by the CMS for fiscal 2015, he said.

Readmission practice patterns for those procedures have been re-evaluated. The hospital also is addressing coding concerns that led to poor performance on patient-safety indicators.

Palisades officials, representing the most penalized hospital in the nation, did not provide comment. But noticeable on the hospital’s home page is a link to a Joint Commission public notice that offers patients information on how to complain to the national accrediting body.

The combined penalties or rewards were derived by combining the percentages for the three quality programs included in the Patient Protection and Affordable Care Act. In 2015, hospitals can be penalized for excessive 30-day readmissions up to 3% of revenue from base operating diagnostic-related group payments by the CMS. The value-based purchasing program rewards or penalizes hospitals up to 1.5% of Medicare revenue based on a suite of quality indicators.

New in 2015 is a 1% penalty on all Medicare revenue if a hospital falls into the bottom quartile in performance on hospital acquired conditions, or HACs, such as urinary catheter infections.

The escalating penalties are drawing fire from advocates for teaching hospitals and critical-access hospitals, which are disproportionately represented among the worst-performing hospitals. The CMS programs need to be refined to ensure they are not creating additional hardships, said Dr. Atul Grover, the chief public policy officer for the American Association of Medical Colleges, which represents the nation’s academic medical community.

AAMC members take on more complex cases and are more likely to report bad outcomes. “You may not be comparing the same types of patients and the same types of procedures across institutions,” Grover said. “We need to refine the measures so they are not creating adverse comparisons.”

Academic medical centers were among the more heavily penalized hospitals in the nation, according to the Modern Healthcare analysis. The University of Colorado Hospital in Aurora will be docked 2.18% on much of its Medicare reimbursements; St. Peter’s University Hospital in New Brunswick, N.J., faces a combined 2.50% penalty; and Thomas Jefferson University Hospital in Philadelphia had a 3.01% reduction.

Overall, 42 hospitals will face a combined penalty of 3% or higher on much of their Medicare revenue for fiscal 2015.

Despite perceived flaws with CMS quality and safety incentive programs, hundreds of facilities are getting it right. They improved their performance from year to year and face low penalty rates. Nearly 800 of the nation’s hospitals face either no penalties or will be earning rewards based on their performance in the value-based purchasing program.

Bucks County Specialty Hospital in Bensalem, Pa., for example, will see a fiscal 2015 reimbursement boost of 2.09% after earning the nation’s highest reward in the value-based purchasing program. The acute-care hospital did not see a 30-day readmission fine in 2013, 2014 or 2015, increased its value-based purchasing reward significantly between 2013 and 2015 and has no HAC penalty in 2015.

Some hospital leaders warn that the combined cuts across all Medicare penalty programs may have a cascading effect on services and may actually lead to reduced quality. This will have a “significant impact on hospitals’ bottom lines and can lead to some very tough choices,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals.

The 220-member national association, which represents the nation’s safety net hospitals and health systems, says the organization’s members are operating at a 4% loss on average, and when additional cuts are added, services aiding the community that are not typically reimbursed such as free clinics, language translations and transitional housing may be the first on the chopping block.

Unless Congress reverses the programs—an unlikely event—higher penalties are expected in coming years. The combined financial impact is expected to be sizeable.

By 2017, the combined penalties for HAC 30-day readmissions and value-based purchasing will put as much as 5.5% of inpatient Medicare payments at risk.

Nearly Half of Patients Withheld Info in Their EHR

In what is being touted as the first real-world trial of the impact of patient-controlled access to electronic health records, almost half of the patients who participated in the study withheld clinically sensitive information in their EHR from some or all of their healthcare providers.

During the six-month trial, a partnership between Regenstrief, the Indiana University School of Medicine, and safety net provider Eskenazi Health, 105 patients in an Eskenazi Health primary care clinic were able to indicate preferences for which clinicians could access sensitive information in their EHRs, such as information on sexually transmitted diseases, substance abuse or mental health, and designating what the clinicians could see.

Regenstrief informatics developers created a system where those preferences guided what information doctors, nurses and other clinic staff could see. Patients were able to hide some or all of their data from some or all providers. Forty-nine percent of the 105 patients who participated elected to withhold information contained in their medical record from some or all of their providers.

Patients strongly desired such control, while their providers had mixed reactions. Some providers were fine with it as long as patients knew that hiding information could adversely affect their care, and they were willing to take that risk. Other providers strongly objected to not being able to see all of the information in their patients’ records, not wanting to be responsible for bad or unsafe care.

Importantly, the providers were able to override patients’ preferences and view any hidden data, if they felt the patient’s healthcare required it, by hitting a “break the glass” button on their computer screens. When providers hit this button, the program recorded the time, the patient whose electronic chart was being viewed, and the data displayed.

“To the best of our knowledge, a trial like ours has never been attempted before, and we believe it presents an opportunity to shape national policy based on evidence,” said Regenstrief President and CEO William Tierney, M.D., principal investigator of the project. “We learned that patients have widely different opinions of what kinds of their healthcare data they would like visible to different members of their healthcare team and others, such as health services researchers, who might have access to information in their electronic medical record.”

The results of the trial are presented, interpreted, and analyzed in five peer-reviewed research papers describing how the patient-controlled system was developed, how the trial was conducted and how patients and their providers felt about patient control; a point-counterpoint discussion; and commentaries that comprise the January 2015 supplement to the Journal of General Internal Medicine.

The work was supported in part by a $1.6 million grant from the Office of the National Coordinator for Health Information Technology to the Indiana Health Information Technology Corp.

EHR Data Integrity a Top Health IT Hazard In 2015

A lack of EHR data integrity as a result of incorrect or missing data trails only alarm hazards on the ECRI Institute’s Top 10 Health Technology Hazards for 2015.

“Many care decisions today are based on data in an electronic health record (EHR) or other IT-based system,” the ECRI report states. “When functioning well, these systems provide the information clinicians need for making appropriate treatment decisions. When faults or errors exist, however, incomplete, inaccurate, or out-of-date information can end up in a patient’s record, potentially leading.”

For the second-straight year, alarm hazards lead the list of top health IT hazards. Data integrity, however, is new to the list but comes in very high.

According to ECRI, incorrect and missing data in EHRs and other health IT systems pose a significant challenge as a result of the causes and effects. “What makes this problem so troubling is that the integrity of the data in health IT (HIT) systems can be compromised in a number of ways, and once errors are introduced, they can be difficult to spot and correct,” the institution adds.

This year’s report lists several data integrity failures that could lead to patient safety risks:

Appearance of one patient’s data in another patient’s record (i.e., a patient/data mismatch)

Missing data or delayed data delivery (e.g., because of network limitations, configuration errors, or data entry delays)

Clock synchronization errors between different medical devices and systems

Default values being used by mistake, or fields being prepopulated with erroneous data

Inconsistencies in patient information when both paper and electronic records are used

Outdated information being copied and pasted into a new report

Adding to the challenge of addressing this hazard is the difficulty of identifying events and finding resolutions because of the end-user’s inability to recognize health IT-related failures.

ECRI has fur recommendations for healthcare organizations and providers to mitigate the patient safety risks associated with a lack of EHR data integrity:

• Before implementing a new system or modifying an existing one, assess the clinical workflow to understand how the system is (or will be) used by frontline staff, and identify inefficiencies as well as any potential error sources.

• Thoroughly test an EHR or any other HIT system and the associated interfaces to verify that the system is properly and fully implemented and that it behaves as expected (during initial implementation as well as after any system changes).

• Institute a comprehensive training program, and have users demonstrate competence before being allowed to use the HIT system. Provide venues for end users to seek help (e.g., easy access to superusers) when working with a new system or feature.

• Establish avenues to report and investigate HIT-related incidents, near misses, and hazards within the organization, as well as to ECRI Institute and other relevant organizations.

CDC, ONC Target EHR-Based Ebola Screening

An initiative launched last year by the Centers for Disease Control and Prevention and the Office of the National Coordinator for Health IT to help providers meet Stage 1 and 2 meaningful use public health objectives is now focusing its efforts on Ebola electronic screening tools.

In August 2013, CDC and ONC established the Public Health Electronic Health Records Vendors Collaboration Initiative. However, with recently confirmed cases of Ebola in the United States, the initiative—which includes public health practitioners and EHR vendors—is currently aimed at trying to get vendors to configure EHR systems to support screening protocols for the deadly disease.

“The overall goal here is for us to explore ways in which the electronic medical record can serve as a prompt to help our healthcare professionals around the country identify individuals that may be at risk for Ebola,” said Dana Meaney Delman, M.D., deputy lead of CDC’s Medical Care Task Force (Ebola Response), during an Oct. 16 CDC/ONC webinar soliciting industry feedback.

“This is a special edition of our normal community of practice calls that we hold with public health and the EHR vendor community,” added Jim Daniel, public health coordinator at ONC. “We do meet on a monthly basis. Please send an email to meaningfuluse@cdc.gov so you can join this group. We talk about other public health and meaningful use measures normally, and we’ll be focusing on Ebola as long as we need to.”

According to a statement from the group, “the EHR vendor community has responded with components within their respective tools to address Ebola and assist within a healthcare environment.” Jon White, M.D., ONC’s acting chief medical officer, told the webinar audience on Thursday that CDC and ONC will be having a separate follow-on call with members of the HIMSS Electronic Health Record Association to gain input.

The CDC has developed a clinical algorithm for “evaluation of the returned traveler” and a checklist for patients being evaluated in the U.S. for Ebola. The objective of the Public Health EHR Vendors Collaboration Initiative is to include a travel history and assessment of pertinent clinical signs and symptoms in an electronic format that can help clinicians diagnose patients infected with Ebola and to isolate them. According to Delman, CDC wants to “ensure that there are mechanisms for healthcare providers to rapidly identify individuals that may have suspected Ebola” and “how we can translate this algorithm into an electronic medical record prompt and perhaps even a decisional tool.”

A patient’s travel history, in particular, is seen as a critical component in properly identifying and confirming a case of Ebola based on symptoms consistent with the virus. CDC has called for increased vigilance by healthcare providers in inquiring specifically about a patient’s history of travel to West Africa—ground zero for the Ebola outbreak.

In related news, mapping and modeling software is helping to track confirmed cases of Ebola infections and to predict where the outbreak might spread geographically over time, according to Chris Woods, M.D., with the Duke Global Health Institute. Citing modeling data from the CDC, Woods revealed that there are basically two scenarios for the Ebola epidemic over the next six months.

The best case scenario, he said, is one in which “70 percent of those affected are put into healthcare systems and into isolation, removed from the general population—where it’s about 18 percent right now.” However, Woods warned that “if things, conversely, continue as they have been—doubling rates every couple of weeks—we’re looking at 1 to 1.5 million cases over the next six months.” And, he added, “it increases the likelihood we’re going to have more and more exposures of the type we’ve had in Dallas.”

Hundreds of FL Patients Affected by Data Breach

Hundreds of Tampa General Hospital patients have had their personal data stolen, the hospital said Friday.

The information included names, addresses, dates of birth, Social Security numbers, admitting diagnoses, and insurers, the hospital said in a media release.

In total, the hospital has sent letters to 675 patients, letting them know they have been affected. Those impacted were scheduled for surgical procedures between October 3, 2011 and August 7, 2014, according to Tampa General.

The hospital said that they have mailed notices to the affected patients. They said they have also set up a call center for the patients to get more information. That number is 1-877-202-4625.

The data breach came to light when the Tampa Police Department contacted the hospital to tell them that, during an arrest, they found four one-page patient cover sheets. The person who was arrested was not a TGH employee, the hospital said.

According to John Dunn, a hospital spokesperson, the information was traced back to unnamed employee, who has been with TGH since 2007 in a non-clinical role.

“(She) would enter orders, do help with scheduling,” said Dunn. “So they were allowed access to medical records, but not allowed to be accessing those records.”

Dr. Jay Wolfson, a professor of Public Health, Medicine & Pharmacy at USF, tells FOX 13 hospitals are making strides in patient confidentiality, but even those with tight security measures are still vulnerable.

“Health care institutions are the single largest source of identity theft in America right now,” said Wolfson. “If it’s happening there, it’s happening elsewhere.”

According to Wolfson, that’s because, in a hospital setting, there are often many documents in a patient’s file and many hands accessing that information.

“It’s vital that whoever’s touching them has exclusive privileges to touch only the part they’re authorized and need to touch,” Wolfson said.

The hospital has set up a call center for the patients to get more information. That number is 1-877-202-4625.

The IRS is conducting its own investigation to see if the employee committed a crime, according to Tampa police.

Medicare HMO Fined, Frozen

Florida Healthcare Plus, a Medicare HMO and drug plan, is under state review for making a $600,000 error in a financial statement and has been temporarily blocked from enrolling any new members, its chief executive says.

The company, based in Coral Gables, was also recently fined $113,200 by the federal Centers for Medicare and Medicaid Services (CMS) for a different type of infraction — “systemic failures” to provide all the benefits due to members under CMS rules.

The fine was explained in a July 17 letter to Florida Healthcare Plus’ CEO Susan Molina from Gerard J. Mulcahy, director of the CMS enforcement group for Medicare Advantage and drug plans. He wrote that in a December 2013 review, CMS determined that the plan had delayed or denied some patients’ access to their medications. Also, some of the HMOs’ members who filed complaints or appeals faced inappropriate delays or denials of the right to access a health service, the letter said.

Molina was not in charge at the time of the December audit. She was brought in by investors to turn the HMO around in January.

The accounting error, which occurred this summer, involved a duplicate listing of a capital contribution  on a quarterly report to the Florida Office of Insurance Regulation, Molina said.  “They caught it; we didn’t, unfortunately,” she said.

The error caused the HMO to fall below the required amount in capital reserves by a small amount, which was quickly rectified, Molina said. But the damage was done.

“The state of Florida asked us to stop enrolling until they can complete an investigation of our financials to make sure everything is okay,” Molina said.  She said the review would start next week and that OIR officials would be on-site Sept. 15.

OIR spokesman Harvey Bennett said the agency cannot confirm or comment on any ongoing reviews.

The enrollment freeze will have only a minor impact unless it lasts more than a month. Open-enrollment season for Medicare plans begins Oct. 15. Florida Healthcare Plus has only 11,000 members.

“We’re small but we believe we can  make it through this,” Molina said.

The plan has been in trouble with CMS before, as Health News Florida reported in April. The federal agency fined the plan more than $40,000 that month for failing to notify its members in the fall of 2013 of the changes in the plan for 2014.

Aside from its headquarters in Miami-Dade County, Florida Healthcare Plus also has an office in Tampa.