IAHCSMM annual meeting report by hdmu096


									October 5, 2012

Why isn’t the U.S. the Best? Results from the National Score Card on the U.S. Health system performance for 2008

Every family wants the best care for an ill or injured family member. Most are grateful for the care and attention received. Yet, evidence in the
National Scorecard on U.S. Health System Performance, 2008, shows that care typically falls far short of what is achievable. Quality of care
is highly variable, and opportunities are routinely missed to prevent disease, disability, hospitalization, and mortality. Across 37 indicators of
performance, the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with benchmarks of best
performance achieved internationally and within the United States.

Even more troubling, the U.S. health system is on the wrong track. Overall, performance has not improved since the first National Scorecard
was issued in 2006. Of greatest concern, access to health care has significantly declined. As of 2007, more than 75 million adults—42
percent of all adults ages 19 to 64—were either uninsured during the year or underinsured, up from 35 percent in 2003. At the same time,
the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries.

The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised
the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates. The
exception to this overall trend occurred for quality metrics that have been the focus of national campaigns or public reporting. For example, a
key patient safety measure—hospital standardized mortality ratios (HSMRs)—improved by 19 percent from 2000–2002 to 2004–2006. This
sustained improvement followed widespread availability of risk-adjusted measures coupled with several high-profile local and national
programs to improve hospital safety and reduce mortality.

Hospitals are showing measurable improvement on basic treatment guidelines for which data are collected and reported nationally on federal
websites. Rates of control of two common chronic conditions, diabetes and high blood pressure, have also improved significantly. These
measures are publicly reported by health plans, and physician groups are increasingly rewarded for results in improving treatment of these

The U.S. spends twice per capita what other major industrialized countries spend on health care, and costs continue to rise faster than
income. We are headed toward $1 of every $5 of national income going toward health care. We should expect a better return on this
investment. Performance on measures of health system efficiency remains especially low, with the U.S. scoring 53 out of 100 on measures
gauging inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use
of information technology. Lowering insurance administrative costs alone could save up to $100 billion a year at the lowest country rates.
National leadership is urgently needed to yield greater value for the resources devoted to healthcare.

The National Scorecard includes 37 indicators in five dimensions of health system performance: healthy lives, quality, access, efficiency, and
equity. U.S. average performance is compared with benchmarks drawn from the top 10 percent of U.S. states, regions, health plans,
hospitals, or other providers or top-performing countries, with a maximum possible score of 100. If average U.S. performance came close to
the top rates achieved at home or internationally, then average scores would approach 100. In 2008, the U.S. as a whole scored only 65,
compared with a score of 67 in 2006—well below the achievable benchmarks. Average scores on each of the five dimensions ranged from a
low of 53 for efficiency to 72 for healthy lives. Overall, national scores declined for 41 percent of indicators, while one-third (35%) improved,
and the rest exhibited no change (or were not updated). (Commonwealth Fund) Click here for the complete study

HHS, Providence Health & Services agree on corrective action plan to protect health information

The U.S. Department of Health & Human Services (HHS) has entered into a Resolution Agreement with Seattle-based Providence Health &
Services (Providence) to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and
Security Rules. In the agreement, Providence agrees to pay $100,000 and implement a detailed Corrective Action Plan to ensure that it will
appropriately safeguard identifiable electronic patient information against theft or loss.

The Privacy and Security Rules are enforced by HHS’ Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services
(CMS). The Privacy and Security Rules require health plans, health care clearinghouses and most health care providers (covered entities) to
safeguard the privacy of certain individually identifiable health information and meet additional security standards for patient information
maintained in electronic form. The Resolution Agreement relates to Providence’s loss of electronic backup media and laptop computers
containing individually identifiable health information in 2005 and 2006.

The incidents giving rise to the agreement involved two entities within the Providence health system, Providence Home and Community
Services and Providence Hospice and Home Care. On several occasions between September 2005 and March 2006, backup tapes, optical
disks, and laptops, all containing unencrypted electronic protected health information, were removed from the Providence premises and were
left unattended. The media and laptops were subsequently lost or stolen, compromising the protected health information of over 386,000
patients. HHS received over 30 complaints about the stolen tapes and disks, submitted after Providence, pursuant to state notification laws,
informed patients of the theft. Providence also reported the stolen media to HHS. OCR and CMS together focused their investigations on
Providence’s failure to implement policies and procedures to safeguard this information.

Under the Resolution Agreement, Providence agrees to pay a $100,000 resolution amount to HHS and implement a robust Corrective Action
Plan that requires: revising its policies and procedures regarding physical and technical safeguards (e.g., encryption) governing off-site
transport and storage of electronic media containing patient information, subject to HHS approval; training workforce members on the
safeguards; conducting audits and site visits of facilities; and submitting compliance reports to HHS for a period of three years. The
Resolution Agreement and Corrective Action Plan can be found on the OCR Web site at http://www.hhs.gov/ocr/privacy/enforcement/

Latest CDC data show more Americans report being obese

The proportion of U.S. adults who self report they are obese increased nearly 2 percent between 2005 and 2007, according to a report in
Morbidity and Mortality Weekly Report (MMWR). An estimated 25.6 percent of U.S. adults reported being obese in 2007 compared to 23.9
percent in 2005, an increase of 1.7 percent. The report also finds that none of the 50 states or the District of Columbia has achieved the
Healthy People 2010 goal to reduce obesity prevalence to 15 percent or less.

In three states – Alabama, Mississippi, and Tennessee – the prevalence of self-reported obesity among adults age 18 or older was above 30
percent. Colorado had the lowest obesity prevalence at 18.7 percent. Obesity is defined as a body mass index (BMI) of 30 or above. BMI is
calculated using height and weight. For example, a 5-foot, 9-inch adult who weighs 203 pounds would have a BMI of 30, thus putting this
person into the obese category.

“The epidemic of adult obesity continues to rise in the United States indicating that we need to step up our efforts at the national, state and
local levels,” said Dr. William Dietz, director of CDC's Division of Nutrition, Physical Activity, and Obesity. “We need to encourage people to
eat more fruits and vegetables, engage in more physical activity and reduce the consumption of high calorie foods and sugar sweetened
beverages in order to maintain a healthy weight.”

The study found that obesity is more prominent in the South, where 27 percent of respondents were classified as obese. The percentage of
obese adults was 25.3 in the Midwest, 23.3 percent in the Northeast, and 22.1 percent in the West.

By age, the prevalence of obesity ranged from 19.1 percent for men and women aged 19-29 years to 31.7 and 30.2 percent, respectively, for
men and women aged 50-59 years.

“Obesity is a major risk factor for a number of chronic diseases such as type 2 diabetes, heart disease and stroke. These diseases can be
very costly for states and the country as a whole,” said Deb Galuska, associate director for science for CDC′s Division of Nutrition, Physical
Activity and Obesity. To learn more about CDC′s efforts in the fight against obesity or for more information about nutrition, physical activity,
and maintaining a healthy weight, visit http://www.cdc.gov/nccdphp/dnpa.

Amerinet announces Emergency Management Planning for Healthcare audio conference series

Amerinet announces a series of Emergency Management Planning for Healthcare audio conferences. These sessions will be conducted on
Wednesday, July 30, and Wednesday, August 20. The intended audience includes members of the incident command team; vice presidents
of operations; facility managers; safety and risk managers; emergency planners; and nursing, clinical and support departments involved with
the emergency management process.

The topics for the two sessions are: Wednesday, July 30 – “The Planning Process” – Topics range from conducting and applying a hazard
vulnerability assessment/analysis to writing a usable 30-page plan for your organization and maintaining situational awareness.

Wednesday, August 20 – “A Focus on Small & Rural Healthcare Facilities” – Participants will learn how to adapt broad emergency planning
concepts to the specific operational environment of small and/or rural healthcare settings.
Each presentation will begin at 1:15 p.m. EDT. Frederick V. Peterson, Jr., will serve as the presenter for both sessions. He is vice president
of professional services and emergency management at the Hospital Council of Western Pennsylvania.

The presentations are $79.00 per connection per program for Amerinet members and $99.00 per connection per program for non-members.
Each audio conference offers 1.5 hours of continuing education credit. To register, please visit Inquisit, the education division of Amerinet, at

3M Health Care and Greystone Pharmaceuticals, Inc. announce license agreement for wound care technology

3M Health Care and Greystone Pharmaceuticals, Inc. have announced they have entered into an exclusive, worldwide license agreement for
wound care products using Greystone’s patented PHI technology, a proprietary formulation that aids in the management of hard-to-heal

This is the second agreement between 3M Health Care and Greystone Pharmaceuticals, Inc. The first agreement provided 3M Health Care
limited distribution rights in Canada and parts of Europe. This new agreement broadens 3M Health Care’s rights to the United States and
most major countries in the world, starting with the introduction of 3M Tegaderm Matrix Dressing with PHI technology to the U.S. market. In
addition, 3M Health Care will be able to extend the PHI technology platform to other wound care products.

Largest review of office-based plastic surgery confirms safety in accredited facilities

A study examining plastic surgery procedures performed in accredited outpatient facilities found that office-based surgery is as safe as
surgery performed in hospitals. The study published in July's Plastic and Reconstructive Surgery (PRS), the official medical journal of the
American Society of Plastic Surgeons (ASPS), reviewed more than 1.1 million procedures and found the mortality rate to be significantly less
than one percent or 0.002 percent.

The study reviewed data collected from January 2001 through June 2006 by The American Association for Accreditation of Ambulatory
Surgery Facilities (AAAASF), which mandates biannual reporting of all complications and fatalities. The study found deaths occurring at
office-based surgery facilities are rare. More than 1.1 million operative procedures in AAAASF-accredited office-based outpatient surgery
centers were studied from 2001-2006. Deaths were infrequent, occurring 2.02 in 100,000 procedures or 0.002 percent, which is comparable
to the overall risk of such procedures performed in hospital surgery facilities. The vast majority of deaths were due to pulmonary embolism (a
blood clot that travels to the lungs, blocking major blood vessels). Pulmonary embolism is an uncommon cause of death associated with any
type of surgery whether elective or medically necessary.

These new findings contribute to a growing safety record for office-based surgery procedures. A 2004 PRS journal study examined 400,000
operative procedures in AAAASF-accredited office-based outpatient surgery centers from 2001-2002 and found that death occurred in 1 in
59,000 procedures or 0.0017 percent.

Nearly 11.8 million cosmetic surgery procedures were performed in 2007, up 59 percent since 2000, according to ASPS statistics. Fifty-nine
percent of cosmetic surgery procedures were performed in an office-based facility, 21 percent in a free-standing ambulatory surgical facility,
and 20 percent in a hospital.

Many hospital claims denials by recovery audit contractors are overturned, as process itself is questioned

Hospitals may be able to fend off recovery audit contractor (RAC) claims denials for medically unnecessary admissions or services because
some of them have been overturned, experts tell RMC. If RACs are too quick to reject admissions because they don't meet screening criteria
(e.g., InterQual) without looking at the entire medical record, hospitals may be able to reverse them. The best approach, however, is to have
an effective up-front process that provides ample documentation of the decision making behind an inpatient admission as described in the
Medicare Benefit Policy Manual.

Meanwhile, there's evidence that RACs may rush to judgment about some inpatient admissions, physician, Robert Corrato, M.D., CEO of
Executive Health Resources tells RMC. For example, CMS appeals contractors and administrative law judges overturned more than 1,000
RAC claims denials appealed by hospitals in four states toward the end of the RAC pilot, which wrapped up in March, says Corrato, whose
organization helped the hospitals mount appeals. The hospitals were able to prove that the admissions and/or services were medically
necessary, he says.

However, CMS says that only 5% of RAC determinations were overturned on appeal from the beginning of the pilot through Oct. 31, 2007.
"CMS does not expect this number to change significantly once the evaluation report of the three-year demonstration is released," a CMS
official tells RMC. About 40% of the overpayments identified by RACs were based on their assertions that the services lacked medical
necessity. But Corrato notes that "when the 5% figure was computed, very few cases had advanced to the third level of appeal (the ALJ)"
and "CMS's own statistics...indicate that 44.2% of appealed cases were decided in favor of the provider." This article has been excerpted
from AIS's Report on Medicare Compliance (RMC). To access the story in its entirety, visit http://www.aishealth.com/Bnow/hbd070308.html.

Next generation Bair Paws Gown simplifies positioning, adds versatility

The world’s first forced-air warming gown now offers clinicians even more flexibility in the OR. Currently, the Bair Paws gown is used in more
than 1,000 facilities in the U.S. and provides both comfort and clinical warming throughout the perioperative period. By incorporating a
second clinical hose port to the lower portion of the Bair Paws+ gown, clinician access is simplified and the need to re-position the gown
when a procedure requires lower body warming is eliminated.

New Bair Paws gown benefits include: Additional flexibility for lower body warming needs; Two clinical hose ports, which eliminate the need
to re-position the gown; Both clinical ports include a hose port card, ensuring the unused port is conveniently presealed; Easy pre-induction
warming through the gown’s lower clinical port; Patient-friendly post-operative clinical warming; The Bair Hugger warming unit can be
conveniently positioned for use in the lower clinical port. As always, the same gown offers clinical warming in the OR for select surgical
procedures. The Bair Paws gown remains with the patient to warm in PACU, with both comfort and clinical capabilities. www.arizant.com

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