Issues & Legislative Committee Reports

January 10, 2008

TJC / GPO Oversight Committee

Joint Commission:
In the current issue of Healthcare Purchasing News, the new JC president, Mark Chassin admitted that their business has shrunk by 20% over the past 5 years. He attributes this to tighter hospital budgets and an increased number of other specialized accreditors.

Quality / Medication Errors / Safety Issues

“Standards Coalition endorses standards for organizational and product identifiers” Healthcare Purchasing News, December 2007, pg. 8.

The Healthcare Supply Chain Standards Coalition is calling for industry-wide adoption of organizational and product identifiers from GS1, an international organization dedicated to designing and implementing supply chain standards. The Standards Coalition, a group of 28 organizations representing the whole healthcare supply chain, is endorsing GS1’s Global Location Number (GLN) for organization identification. The coalition conducted a survey and found that 69% were considering adopting an organizational identifier and almost 2/3 said they were considering adopting GS1’s GLN.  The Standards Coalition is working with GS1 to enhance its standards to meet healthcare’s needs. It is also recommending GS1’s Global Data Synchronization Network serve as the healthcare industry’s system for registering, validating, disseminating and synchronizing product identification information. The Coalition plans to soon introduce implementation roadmaps for supply chain participants, which includes providers, manufacturers, distributors, and group purchasing organizations. A website has been established for healthcare organizations to learn more about the standards adoption and implementation. WWW.hscsc.org

“Materials management’s role in patient safety”, Healthcare Purchasing News, December 2007, pg. 62.

Today’s materials manager has many issues and challenges – patient safety is the top priority in healthcare.  The pivotal year for healthcare quality and safety considerations began in 1988. Three major reports were issues detailing concerns with our healthcare system. IOM National Roundtable on Healthcare Quality reported 3 types of quality problems – overuse, underused and misuse.  The Advisory Commission on Consumer Protection and Quality presented research showing there is no guarantee that any person will receive high-quality care for any particular health problem. The report stated that the healthcare industry is plagued with over utilization of services, underutilization of services and errors in health care practice. RAND Corporation performed literature reviews of leading peer-reviewed journals between 1993 and 1997 which supported the above findings.

In 2000, the report “To Err is Human: Building a Safer Health System” was issued. This reported that 44,000 to 98,000 Americans died a year as a result of medical errors. IOM published “Crossing the Quality Chasm” which highlighted the need for redesign and presented a road map for the future. After the release of this IOM report, patient safety became one of the foremost concerns in healthcare today.

Patient safety has added a new dimension to the role of materials managers. Materials managers serve as the ‘gatekeepers’ ensuring clinical staff is provided uniform system and products at the appropriate time and place. Materials management also provides staff education before an item arrives on the unit. Policing vendor access in the hospital also ensures only items properly reviewed are brought into the facility.

When evaluating products, safety and clinical efficacy is the first priority, followed closely by price. This ensures the best care is being delivered. To effective address patient safety, materials managers must integrate safety into their existing product evaluation and value analysis processes. Clinicians must be involved from the onset to help assess the operational impact of any system and/or product.

The materials manager’s value analysis teams should be aware of items identified as “safety items”.  Another safety issue to consider is new products and stock outs.  Will the new product be readily available during and after the trial? Finally, materials managers need to educate themselves about regulatory issues regarding patient safety.  They need to keep ahead of the issues so they will no be taken by surprise or locked into a solution that is ineffective or harmful.

Disaster Preparedness & Surge Capacity – Their Associate Costs

An 18 December news report by American Hospital Association (AHA) reported on the Readiness of many states regarding Disaster Preparedness.  However, I believe some of the key points taken from the article/report by TRUST FOR AMERICA’S HEALTH include:

Mass Distribution -- 10 states do not have adequate plans to distribute emergency Strategic National Stockpile vaccines, antidotes, and medical supplies from the Strategic National Stockpile (SNS)

Problems with Management and Contents of the Strategic National Stockpile (SNS)

Progress:
CDC is using a new Technical Assistance Review (TAR) Tool to determine a project area’s ability to respond to a public health emergency that requires the use of SNS assets. The State TAR tool is used to evaluate a state’s ability to receive, stage, store, and distribute SNS assets during a public health emergency.  The Local TAR tool is used to assess a city, county or metro area’s ability to receive, manage and dispense SNS assets. Both review tools are based on a 100-point system.

Concerns:
* The new CDC evaluation system still relies on an evaluation of paper-plans instead of an actual assessment of a state’s ability to distribute medicine and supplies in an emergency.
* States still have not received clear information about the quantities of medications and supplies that are in the SNS and how effective the federal government would be in delivering supplies to states during a multi-state crisis.
* The federal government has stockpiled only 6,000 treatment courses of pediatric antivirals for influenza. There are 73.6 million children in the U.S.
* Beginning in 2008, several lots of the anthrax vaccine BioThrax will begin to expire, which could cost the SNS $100 million in lost stockpile in FY 2008 and FY 2009.

Extremely Limited Surge Capacity for Emergencies

Progress:
* A majority of hospitals report they have either established plans or been involved in state and local planning efforts to prepare for a surge of excess patients by planning to use alternative care sites such as schools, conference centers, hotels, and sports arenas.
* Two major reports on surge capacity and hospital preparedness were published in 2007. In April CDC’s Injury Center published In a Moment’s Notice: Surge Capacity for Terrorist Bombings: Challenges and Proposed Solutions, and in October PriceWaterhouseCooper’s published Closing the Seams: Developing and Integrated Approach to Health System Disaster Preparedness. Both reports contain consensus-based recommendations for improving U.S. surge capacity.  Both reports give excellent Examples and Action Points for Supply Chain Managers to look at and determine if they need to address those in their own section of the Emergency Plan or if it needs to be raised to more of a Corporate level decision and action.  The CDC Report uses the Madrid Train Event as an example of numbers of patients, the rate at which they presented to either Emergency Room, Community Health Centers, etc.  Additionally, it gave a good view of the timeframe that supply chain managers would have to operate within.
* The PriceWaterhouseCooper report spoke to the assets that are available, like in the SNS, but that a potential failing point is the ability to get the material to where it needs to be at either the critical time or location, and even the manpower to support those efforts. 

Concerns:
* According to the Center for Biosecurity, the minimum costs of developing and maintaining surge capacity during a severe pandemic for an average size hospital are close to a $1 million one-time investment coupled with $200,000 in annual maintenance costs. Current ASPR-funding levels are closer to approximately $100,000 per year per hospital.
* The public health workforce and healthcare workforce shortages continue to worsen.
* Ongoing concerns exist about policies and incentives designed to encourage healthcare workers to report for duty during an emergency.
* Volunteer medical workforce efforts are limited by concerns regarding liability and licensing

The Second National Emergency Management Summit, Feb 3-5, http://www.emergencymanagementsummit.com/index.html, will cover in its Pre-conference sessions “Hospital Surge Capacity Update” with topics like: Overview of the Science of Surge; Taking Surge on the Road: How to Fund, Develop and Operationalize a Medical Field Surge Unit; Hospital Surge Strategies: Pros and Cons; Utilizing Volunteers in Assisting in Surge Capacity Assessments; and Hospital Surge Capacity Strategies to Prepare for an Epidemic

The Conference is being sponsored by: The Harvard Health Policy Review, Health Affairs, The Joint Commission, International Association of Emergency Managers, The American Association for the Surgery of Trauma, The Emergency Nurse Association and The World Association for Disaster & Emergency Medicine.