Issues & Legislative Committee Report

March 8, 2007

JCAHO / GPO Oversight Committee

Joint Commission
Announced Feb. 26 that CMS (Centers for Medicare & Medicaid Services) has granted the commission a 5 year extension of its laboratory CLIA certification authority.
 
National Patient Safety Goals - Medication Safety:  (3B) Broselow Tapes should be upgraded to the new Broselow-Luten color coded system that works in conjunction with the push for constant IV drug concentrations.  MM departments in charge of crash carts should check with their Pharmacies on this.
 
National Patient Safety Goals - Medication Safety:  (3D) Pre-labeled syringes on the market for medication draws are not acceptable.  Pre-filled and labeled are; but all empty syringes should be labeled only as used.
 
A scan of the JC website's Events and Resources sections reveals no significant MM topics for 2007.
 
GPO Antitrust
Have queried both Senators Kohl and Hatch at their website over 2007 GPO antitrust activity--no replies yet.  However, Rick Barlowe's column this month has the issue 9th on the committee's agenda of 12 items, and not likely to be looked at this year or next due to splashier subjects hogging election cycle attention. 

Gainsharing Agreements

Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission presented his report on March 1, 2007 to the U.S. Senate Committee on Finance.
This report hones in on the need to slow the rate of Medicare outlays which occurs via the sustainable growth rate (SGR). This SGR is criticized as being flawed.
This report indicates support for gainsharing agreements as noted below:
“Allowing shared accountability arrangements, including gainsharing between physicians and hospitals, such arrangements might increase the willingness of physicians to collaborate with hospitals to lower costs and improve care.”
In part, this appears to be a way of replacing the reduction of physician payments by Medicare, with gainsharing payments by the hospitals. If done right, hospitals costs will decrease, physicians recoup some Medicare payment losses, and quality does not suffer.

Source: http://www.medpac.gov/publications/congressional_testimony/030107

Consumer Driven Healthcare

1. New web site for consumer information.  WWW.Revolutionhealth.com. It will start in April and cost $100 to join.  Eventually would like to be the Angie’s List for the health care industry with consumers providing information of providers.

2. Center for Studying Health System Change, WWW.hschange.com, issue #109, Benefits Design Innovation Implications for Consumer-Directed Health care. Major issues are system has “value based benefit” in its design, complex process decreases consumer decision making and use of HSAs varies by income of the consumer which decreases its overall value to the system

3. WWW.healthleadersmedia.com, Retail Based Clinics: Passing fad or Here to Stay.  Talks about the trends of the clinics in Wal-Marts and CVSs  and will these sites stay valid. First impressions are that they are well received and fill a need so they will stay.

Disaster Preparedness – Pandemic Flu

Earlier this year the Centers for Disease Control developed and published a rating system for pandemic severity. The system consists of 5 categories or classifications for Pandemic preparedness. On the mild side, a Category 1 Pandemic assumes that approx. 90,000 Americans would die. Category 5 is the most severe classification with an estimated 1.8 million Americans are expected to die. The CDC recommends that emergency organizations prepare for a Category 5 scenario. For reference purposes, the typical annual flu situation results in the deaths of about 36,000 Americans.

To date during 2007, the easy transmission of the Avian Flu strain H5N1 from Human to Human has not materialized. The virus while continuing to be transmitted to humans from birds the rate of transmission has not increased. The eventual mutation of this virus continues to be monitored closely by health agencies around the globe.

Infection Control

Pandemic Influenza
On Feb. 5, HPN News reported an outbreak of bird flu among turkeys on a poultry farm which had killed 2500 turkeys.  This has been the biggest outbreak reported in Britain, and resulted in the culling of 160,000 birds.  Over the past month, HPN News has also reported on several cases of human infection with H5N1 that have occurred in Nigeria, Egypt and China.  In all three cases, there had been human contact with infected birds.

On Feb. 7th, the New York Times reported that Indonesia was considering selling the H5N1 virus to Baxter Healthcare, and has stopped sending samples to the World Health Organization.  A spokesperson for Baxter said that the company had not required Indonesia to stop sending in samples to WHO, and that the agreement under negotiation would not be exclusive.  There have been many concerns that this could set a dangerous precedent, since currently seasonal flu samples are donated from all over the world.  Often, poor countries who donate the strains of the virus do not have access to the flu vaccine when it is released, although up till now there has not been much demand for it.

OSHA has released new guidelines for preparing workplaces for an influenza pandemic.  Workplaces are divided into four risk zones, and recommendations for worker protection are made as determined by the employee’s likelihood of exposure.  OSHA has emphasized that this plan is a dynamic plan that may evolve and change over time.  The most up to date information is listed on their website at www.pandemicflu.gov. 

On Feb. 15, the New York Times carried an article in which scientists warns that despite a decrease in news coverage on the H5N1 virus, it remains as dangerous and unpredictable as ever before.  It is actually out of control in birds in more locations than last year, and have hit hard in countries such as Indonesia, Nigeria and Egypt , who are more challenged due to their weak public health systems.

Statistics on Hospital Acquired Infections:
- HAI’s (Hospital Acquired Infections) cause 90,000 deaths per year, and are the 5th leading cause of hospital death.
- >2 Million cases/ yr making up 5-10% of all acute care hospitalizations
- 120,000 new cases of MRSA per year
- Each case estimated to cost between $27,000--$34,000/yr
- Twice as likely to die from MRSA as from a sensitive Staph organism
- Estimated 17,000 deaths per year
- VRE causes one out of every 3 HAI’s
- More than 70% of the bacteria causing these infections are resistant to at least one of the drugs most commonly used to treat them.
- Cost of Hospital acquired Infections estimated to exceed $5 Billion
- each year

Statistics on Food Acquired Illnesses:
- Listeria:  Two thousand five hundred infections and five hundred deaths annually.
- Salmonella:  Estimated 40,000 cases per year resulting in 1000 deaths per year
- E. coli (O157:H7) :  Seventy – three thousand infections and sixty-one deaths annually.

RFID / Data Standards / E-Commerce

2007 Webinars: GLN Registry for Healthcare
Share location and entity information with your trading partners accurately and easily with Global Location Numbers (GLNs). This Web Seminar introduces GLNs, explains how they can be used to identify physical locations, functional entities, and legal entities in electronic commerce.

This seminar will cover:
• How GLNs are used 
• How GLNs are used in the GDSN 
• The benefits of using GLNs 
• The structure of the GLN

All seminars begin at 2:30 pm ET; duration is 1 hour.
Event Password: Glnregistry (case-sensitive)
Teleconference Dial-In Number: (877) 864-7187
Room Number:  *9821318*
www.chestandards.org
 
 • TUESDAY, FEBRUARY 6, 2007
 • WEDNESDAY, FEBRUARY 21, 2007
 • TUESDAY, MARCH 6, 2007
 • TUESDAY, MARCH 20, 2007
 • TUESDAY, APRIL 3, 2007
 • TUESDAY, APRIL 17, 2007
 • TUESDAY, MAY 1, 2007
 • TUESDAY, MAY 15, 2007
 • TUESDAY, JUNE 12, 2007
 • TUESDAY, JUNE 26, 2007
 • TUESDAY, JULY 10, 2007
 • TUESDAY, JULY 24, 2007
 • TUESDAY, AUGUST 7, 2007
 • TUESDAY, AUGUST 21, 2007
 • TUESDAY, SEPTEMBER 11, 2007
 • TUESDAY, SEPTEMBER 25, 2007
 • TUESDAY, OCTOBER 9, 2007
 • TUESDAY, OCTOBER 23, 2007
 • TUESDAY, NOVEMBER 6, 2007
 • TUESDAY, NOVEMBER 20, 2007
 • TUESDAY, DECEMBER 4, 2007
 • SUNDAY, DECEMBER 16, 2007
 

Quality / Medication Errors / Safety Issues

Background
HHS projects that medication errors alone cost the healthcare system $76 billion per year. The most common error in the medication use history > omitting a medication that is taken at home.

Legislation
House of Representatives – approved July 26, 2006 – Health Information Technology Promotion Act.
Funding for HIT – approved by House and Senate Labor – HHS – Education Appropriations and Subcommittees - $148 and $113.2 million for FY 2007.
Medicare Modernization Act of 2003 – Congress mandates Institute of Medicine (IOM) to carry out a comprehensive study of drug safety and quality issues in order to provide a blueprint for system-wide change.

A new report from the IOM, Preventing Medication Errors. Released July 20, 2006, found that medication errors are very common and costly to the nation. This report states that at least 1.5 million preventable adverse drug evens occur each year.

Eight states have passed laws aimed at reducing prescription drug error. These include: Colorado, Delaware, Florida, Illinois, Maryland, Michigan, Montana, and Tennessee.

Preventing Medication Errors
Currently, less than 20% of prescriptions are electronic.
First step – encourage patients to take a more active role in their own medical care. One of the most effective ways to reduce medication errors is a move toward a model of healthcare where there is more of a partnership between the patients and healthcare providers:
- Healthcare providers must communicate with patients and make it a two-way street
- Patients should take a more active role in the process
- Healthcare systems need to do a better job of educating patients and providing a way for patients to educate themselves.
In addition, HIT reports that quality improvement in prevention of medication errors by use of bedside bar code technology.
- Medication errors cut by 89%.
- ER documentation accuracy improved by 85%
- Overall discrepancies reduced by 71%

Local – Children’s Hospital of Alabama
Implementation of allergy alert bands – hospital-wide September 7, 2006. Since hospital-wide implementation, no medication errors documented.

Sources:
Health Information Technology: Reducing Costs and Increasing Quality
  Kristin Wolgemuth Fitzgerald, Fitzgerald Consulting Inc.
“IOM – Identifying and Preventing Medication Errors”
 http://www.iom.edu/CMS/3809/22526.aspz?printfriendly=true
Report Brief – July 2006
 “Preventing Medication Errors” – Institute of Medicine
“State Initiatives to Avoid Prescription Drug Errors: – December 24, 2006
www.ncsl.org/programs/health/RXerrors.htm

Ethics/ Non-Pharmaceutical Vendor Conduct

The International Herald Tribune published a report on February 13, 2007 detailing Johnson & Johnson’s announcement that “some of its foreign units might have made improper payments related to the sale of medical devices in two ‘small-market countries’.”  Though more details about specific actions or countries involved were not released, the statement noted there were “questionable payments made by some of it’s subsidiaries”. The announcement was accompanied by the subsequent retirement of Michael J Dormer, J&J’s worldwide chairman of diagnostics and devices, a division which has annual sales totaling $20 billion.  Besides breaching internal policy, the company is worried that practices that occurred under Dormer’s command may be in violation of the Foreign Corrupt Practices Act.  The act, which dates back to 1977, addresses the issue of US companies in any sector using funds to persuade foreign government officials to partner.  Though Dormer accepted full responsibility and J&J’s immediate actions may help it avoid sanction, the SEC could still launch a full investigation ultimately resulting in Medicare disqualification.   Dormer had responsibility for Depuy Orthopaedic, Ethicon Wound Care and Endo-Surgery, and Ortho Clinical Diagnostics and was replaced by Nicholas J. Valeriani.  The largest penalty paid under this law was enforced in 2005 and totaled only $30 million.  The announcement came as most shocking due to J&J’s reputation of good-behavior and strong adherence to its ethical credo.

UPN Issues / Data Standards Issues

Healthcare Supply Chain Standards Coalition (formerly the Healthcare Standards Council)
The Healthcare Supply Chain Standards Coalition (HSCSC) is a multi-stakeholder collaborative of senior leaders dedicated to moving healthcare toward the use of uniform standards for business transactions to achieve greater supply chain efficiency and improved patient safety. The group is operating under the auspices of the National Alliance for Healthcare Information Technology (NAHIT).

The Coalition will recommend, promote, and facilitate the implementation of uniform supply chain data standards in the industry. Implementation of these standards will streamline business processes, enhance efficiency at many levels, reduce costs for all healthcare supply chain participants, and improve patient safety.

Scott Wallace of NAHIT wrote a good article on this effort that details what has happened and what needs to happen in Most Wired magazine recently. http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/PubsNewsArticleMostWired/data/07Winter/
070214MW_Online_Morrissey&domain=HHNMOSTWIRED

HSCSC held its last meeting December 12, 2006 in Dallas. AHRMM’s role as an observer was solidified at this meeting, along with SMI, AHA, and CHeS. The group continues to struggle to get distributors to join the coalition. NAHIT and a few volunteer participants agreed to work on this together over the next few months to personally reach out to distributors. AHRMM suggested HIDA be approached as well, which was welcomed. AHRMM will have a seat on two committees – AHRMM’s Past President Bob Perry will serve on the Data and Synchronization Committee and AHRMM staff will have a seat on the Education and Enablement Committee. Both groups met in February, and the Education group met again on March 5th. NAHIT is still working on getting key manufacturers to the table as well. At last call there were still manufacturer openings on the governing group, the Oversight Committee (on which AHRMM has a non-voting observer’s seat). The HSCSC will meet again on March 8 in Chicago.

For complete information on the HSCSC, please visit: http://www.nahit.org, or http://www.nahit.org/cms/index.php?option=com_content&task=view&id=289&Itemid=42.