Issues & Legislative Committee Report

July 13, 2007

JCAHO / GPO Oversight Committee

Joint Commission
For its newly announced 2008 National Patient Safety Goals, JC will discontinue the requirement to limit and standardize drug concentrations.  Instead the requirement will remain only as part of its Medication Management standard.
 
"Speak Up" brochures, part of the Patient Right To Know campaign, are now downloadable from the JC website in Quark format, including instructions to print vendors.  JC allows us to put logos on them and post them as handouts in Admissions.  They're available in both English and Spanish.
 
GPO Oversight
No news from either the Antitrust Subcommittee or HIGPA; but in somewhat related activity the Medical Device Manufacturers Association, the largest critic of healthcare's GPO safe harbor, continues its aggressive lobbying against both the upcoming Medical Device User Fee and Modernization Act renewal; as well as the current CMMS promotion of Gainsharing.  MDMA continues to claim all three government sponsored programs create stiff barriers to small and middle sized device manufacturers.

Gainsharing Agreements

Although the Centers for Medicare & Medicaid Services continues the demonstration project as noted below, it appears that the huge push to participate in formalized gainsharing agreements as outlined in the OIG opinions of 2005 are simply not materializing as many sources have predicted.

Because they received a limited response from rural hospitals to their original solicitation in September 2006, they are re-issuing the solicitation for proposals from rural hospitals only. Rural hospitals that submitted proposals previously are eligible to reapply as well for the 2008 Medicare Hospital Gainsharing Demonstration.

The purpose of this demonstration is to improve the quality and efficiency of care provided to Medicare beneficiaries and to develop improved operational and financial hospital performance with the sharing of remuneration payments between hospitals and physicians in six projects, each project consisting of one hospital. Two projects must be rural. Applications should be received on or before 5 p.m., EST, September 4, 2007.

For further information contact Lisa Waters at (410) 786-6615 or GAINSHARING@cms.hhs.gov. Interested parties can obtain a complete solicitation, application, and supporting information on the following CMS Web site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2006_DRA_5007_
Medicare_Hospital_Gainsharing_Demonstration.pdf

Source: http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/
2007/07-3265.htm

Consumer Driven Healthcare

CMS Posts on-line Comparison of Heart Attacks and Heart Failure Rates
USA Today 6/22/2007
CMS has posted for the first time theses rates to promote quality care and to give consumers information concerning quality of the care they receive at facilities.  The link to this is hospitalcompare.hhs.gov

Physicians in IL are trying to regulate Retail Clinics
Boston Globe 6/18/2007
Physicians in Mass are starting to use the same tactic that IL physicians’ are using to fight the introduction of retail clinics in their markets, fighting to prevent a waiver of licensing requirements.

Latest Retail Health Market – Air Travelers
UPI 6/6/2007
Aero Clinic has opened its first clinic at Atlanta’s Hartsfield – Jackson Airport.  The clinics will target air travelers with basic treatments for cold and flu along with some testing, physicals and routine immunizations.

RediClinics now accepts Medicare at its 46 locations in Houston
Houston Business Journal 6/13/2007

AMA Takes on Retail Clinics
Chicago Tribune 6/25/2007
With broad opposition within its ranks, the AMA is starting to target retail clinics on three main issues:
a. they are unregulated
b. they are staffed with only nurses and Pas
c. patients, especially children could be at risk without a coordinated care plan

Aiming Higher, Results from a State Score Card on Health System Performance
The Commonwealth Fund 6/2007
This is a major report that looks at 32 indicators regarding access, quality and cost.  It shows that leading states consistently outperform lagging states in all indicators.  Their web site is CMWF.org

Price Transparency

This issue came under scrutiny last year when Guidant sued Aspen Healthcare Metrics stating that their consultants had access to private contract information without Guidant’s permission and then shared that information with other hospitals with the purpose of advising them on what to pay for theses products.

In the May 2007 issue of Materials Management Magazine, Robert Neil examined the issues involved in the case in his article “price transparency issue has all sides seeking clarity”   The article describes in detail the major issues in the case.  It also explores some of the possible effects on the hospital and supply chain industries of the court’s decision through interviews with some Consulting Company and GPO executives.   Those interviewed included Al LoBiondo, Chairman of the Health Industry Group Purchasing Association, Alison Smith, Associate Vice President of Nexera Consulting, and John Bardis, President and CEO of Med Assets GPO.

There was also an article in this same issue titled “Gingrich Encourages Price Transparency”.  This article focuses on the fact that the Bush Administration is pushing for more price transparency from hospitals. The Centers for Medicare and Medicaid services says it would begin publishing the government discount rates it pays for common hospital procedures. The US House of Representatives House Energy and Commerce Committee Subcommittee on Health recently held a hearing on this subject, and Newt Gingrich testified that medical device manufacturers should be held to the same price transparency as hospitals.

HFMA has also come out strong on this issue through seminars and articles.  Todd Nelson, CFO of Grinnell Regional Medical Center was interviewed by HFMA for the November 2006 issue of the supply chain newsletter in which he identified and discussed some of the issues faced by hospital executives if pricing transparency does not become a reality.  Pricing for these high cost implants are published in Europe by the same companies that keep pricing so secret here in the US. 

In the February 2007 issue of the HFMA magazine, Todd Nelson writes an article “A Passion for Pricing Transparency”.  He talks about the efforts in the State of Iowa where the Hospital Association has developed a pricing transparency statement that has been fully endorsed by all of the hospitals in Iowa.  The statement talks about the goals and the different key players in the issue of pricing transparency including the payer and the insurance companies as well as the implant vendors.

Ethics / Pharmaceutical and Vendor Gifts

Overview
The purpose of Journal Watch is to help medical professionals stay current with clinical research and standards of practice. To fulfill this mission, the editorial boards select the most important and clinically relevant medical research reports and write critical, authoritative, and timely summaries of that research, including expert commentary. In addition, Journal Watch complements the research summaries with short feature articles, summaries of clinical guidelines, brief summaries of and commentary about medical news, and selected other special articles of clinical interest. 
The Massachusetts Medical Society and the Editors-in-Chief, editorial boards, and staff of Journal Watch recognize that, to fulfill our mission, we must systematically and proactively address conflicts of interest. Financial interests (specifically, ties to industry through employment, equity or stock ownership, honoraria, research grants, etc.) are the most obvious sources of potential conflict. Furthermore, that potential exists when the financial interests are held, at a minimum, by the individual or his or her spouse, committed partner, or dependent children. Conflicts can also arise from nonfinancial sources such as competing editorial responsibilities, academic or professional competition and affiliations, and personal relationships. 
Together, the Massachusetts Medical Society Committee on Publications and the Editors-in-Chief of the Journal Watch editorial sections, as represented by the Editorial Advisory Board, have developed the following Conflict of Interest Policy. This policy provides a framework within which the Editors-in-Chief, editorial boards, and staff can, systematically and with appropriate editorial judgment, address conflict-of-interest issues as they arise. The policy is divided into multiple sections.

Drug Industry Showers Greenbacks on Vermont Docs 
Posted by Jacob Goldstein 
Drug makers gave more than $2 million in cash, checks and food to doctors and other prescribers of drugs in Vermont during fiscal-year 2006, according to a report published yesterday by the state. 
The largest chunk of money — more than $1 million — was for speaking fees. Education and marketing expenses also figured prominently. Vermont law requires drug companies to report the payments but doesn’t cover many marketing costs, such as the expense of drug samples.
Eli Lilly led the spending pack, followed by Sanofi-Aventis, Pfizer, Forest Laboratories and Novartis. Among the top 100 recipients of drug money, psychiatrists stood out, appearing 11 times and collecting a total of more then $500,000, or 22% of the overall amount reported.
The Vermont report, brought to our attention by the blog Pharmalot, comes as the Senate scrutinizes ties between doctors and the drug industry. 
The idea of a national reporting law similar to Vermont’s may be gaining traction. “A federal law requiring public disclosure of payments to doctors could be very effective if it was carefully monitored and consistently applied,” Senator Charles E. Grassley, an Iowa Republican, told the New York Times

Quality / Medication Errors / Safety Issues

Study Finds Many Injuries to Surgeons Go Unreported
http://www.nytimes.com/2007/06/28/health/28needles.html
Most surgeons who accidentally stick themselves with needles and sharp instruments fail to report the injuries. The main reason cited by surgeons for the injuries was being rushed and most injuries were self-inflicted.
Reasons given by surgeons for not reporting these injuries:
  Take too much time
  Could jeopardize career opportunities
  Loss of face among peers

Survey of 699 doctors at 17 hospitals found that 99% experienced at least 1 needle stick and 51% of these failed to report their injuries to employee health as some hospitals require. The strongest predictor for reporting injuries was someone else’s knowledge of the injury.

Medical Misconnections Day 4: Is your nurse on hour 16?
http://www.madison.com/toolbox.index.php?action=printme2&ref=wsj&storyURL=%2Fws
Regulators are starting to consider a radical change: banning nurses from working more than 12 hours in a row, even voluntarily.
Nurse fatigue plays a factor in judgment calls about a patient’s condition. This is an important part of the job of a nurse and becomes difficult when nurses work up to 16 hours in a row.
Nurses working more than 12 hours in a row are 3 times more likely to make mistakes than those working fewer hours.

Ethics/ Non-Pharmaceutical Vendor Conduct

On July 3rd, 2007 the Sacramento Bee reported that the University of California, Davis Health System would be expanding its ban against pharmaceutical industry gifts, lunches, and samples to include any company that is involved in marketing towards healthcare facilities.  The new policy went into effect July 1, 2007 and follows similar policies put in place by Yale, Stanford, UCLA, University of Pennsylvania, and Kaiser Permanente of Northern California.

The ban on freebies is UC Davis’ attempt to provide consistency and product transparency in hopes of keeping the focus on the patient and their healthcare needs.   The policy explicitly encompasses pharmaceuticals, knee replacement parts, heart catheters, IV pumps, and radiation machines but has an umbrella that extends to any medical device, equipment, or service.  One of the most surprising clauses includes prohibition of the medical device representatives who frequently provide technical assistance to surgeons in the OR while using their products unless approved by the health system and deemed essential to the case.

Exceptions to the policy include contracting discounts, research grants, and refreshments during training sessions.  Dr. Claire Pomeroy, vice chancellor and dean of the UC Davis School of Medicine stated she did not “want [vendors] giving any gifts that would either influence or give the appearance of influence to anybody making a decision about which product to stock in [the] clinics or hospital.”  Pomeroy added that as discussion continues on issues such as physician conflicts-of-interest, she could not rule out future changes or additions to the policy.  No details were given about the physicians’ or vendors’ reaction to the change.

Green / Environmental Friendly Purchasing

In my last report the H2E website was listed as: www.geocities.com/EPP_how_to_guide/ the website has been updated as follows: www.h2e-online.org.

The updated website contains a lot of informative information on Hospitals for a Healthy Environment and Environmental Friendly Purchasing.  Included in the most recent update are the 2007 H2E Environmental Excellence Award winners. As stated by Sarah O’Brien in her article in Supply Chains and Strategies May/June issue:
“Each year Hospitals for a Healthy Environment presents its Environmental Excellence Awards to healthcare facilities and organizations across the country demonstrating environmental leadership in healthcare. The accomplishments of this years winners bring home the correlation between environmental improvements and cost savings.”

Also included are upcoming H2E Teleconferences:
July 13, 2007   Green Building Series – Specifying Green Furniture and Furnishings
Topic:  An overview of the environmental and health concerns surrounding furniture and medical furnishings in the healthcare sector and a case study of a project that successfully specified green products throughout the facility.

July 20, 2007    Toxicity and Volume reduction Opportunities in Food Services – A Case by Children’s Hospital and Regional Medical Center in Seattle, WA
Topic:  From waste prevention, to greener cleaners, integrated pest management, composting, reusable and recycling—food services has a lot of opportunity for environmental improvements.  Learn from the team at Children’s of their positive outcomes attributed to changing how they manage food service materials.

July 27, 2007    Introduction to H2E and Data Collection
Topic:  If your hospital is new to H2E this is excellent starting point.

You can register at the H2E website.  Also be sure to check out the H2E Products and Services Directory at www.h2e-online.org/directory/index.htm.

UPN Issues / Data Standards Issues

The HSCSC met in Chicago on July 9. The Organizing Committee gave an update with progress on the budget task force, correspondence with HIMSS and Wal Mart as well as the progress of the three each subcommittees.

The Organizational Identifier Subcommittee did not recommend a standard. The Minnesota Pilot using the GLN has highlighted some issues to address. The conclusions of the pilot are published in a GS1 report. The committee will be sending out a survey this summer to gather information on how many in the industry are using identifiers.

The PDU Subcommittee is discussing attributes – what should be required, etc. Each part of the supply chain has a group of preferred attributes. Other topics of discussion involved housing the data. Should we build our own repository or use the GDSN network of data pools? Building a new one will take time and capital.

The Education and Enablement Subcommittee’s role is being expanded to include recruiting new members. The HSCSC now has its own logo to use on marketing materials.

The Product Identifier Subcommittee also met in Chicago in July and had an educational session with presentations from Australia, DoD, GHX, GS1 Healthcare, DataGility and AdvanTech.

There still are not many distributors at the table, and there was some discussion as to do we need equal representation from all parties at the table. It is generally understood that we need distributor participation. Many members and interested parties are looking for data on what the savings are for each partner in the supply chain. There is not a current healthcare study to point to refer to.