Issues & Legislative Committee Report

August 9, 2007

JCAHO / GPO Oversight Committee

Joint Commission
The JC Annual Conference is set for Nov. 12-14 in Chicago.  In keeping with its current major drives, there will be two tracks offered--one on Quality and one on National Patient Safety Goals.
 
The JC testified July 13 before the congressional Committee on Energy and Commerce about needed tort reform in the medical arena.  In a nutshell JC argued that the national push for transparency in costs and medical errors, along with more open communication between physicians and patients, is at odds with our litigious culture; and that these goals can not be fully realized until tort reform limits liabilities.

Pricing Confidentiality / Transparency

501 c (3) non-profit status of hospitals
Senator Charles Grassley (R-IA) on the Senate Finance Committee is looking very critically at the non-profit status of hospitals and healthcare entities, questioning if they are providing a community benefit commensurate with the advantages they gain via their non-profit status.
-  July 19th the IRS released a preliminary report re the responses received to a 500 hospital survey on this topic. View the IRS press release, the IRS report Hospital Compliance Project Interim Report, and Senator Grassley's reaction at http://finance.senate.gov/press/Gpress/2007/prg071907c.pdf
-  Tax-Exempt Hospitals: Discussion Draft   - on July 18th Sen. Grassley released a staff report on recommended nonprofit hospital reforms, requesting comments/feedback. This report contains recommendations pertaining to joint ventures, corporate governance, executive perquisites, billing and collection practices, and minimum charity care standards, etc.  It would seem that the direction he is going in would be to legislate defined, concrete levels of charity care that hospitals would have to provide to maintain their non-profit status.

CMS’ Hospital Compare web site
Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. On this site, the consumer can see the recommended care that an adult should get if being treated for a heart attack, heart failure, or pneumonia or having surgery. The performance rates for this website reflect care provided to all U.S. adults. This website was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), along with the Hospital Quality Alliance (HQA). The Hospital Quality Alliance (HQA): Improving Care Through Information was created in December 2002. The HQA is a public-private collaboration established to promote reporting on hospital quality of care. The HQA consists of organizations that represent consumers, hospitals, doctors, employers, accrediting organizations, and Federal agencies. The HQA effort is intended to make it easier for the consumer to make informed healthcare decisions, and to support efforts to improve quality in U.S. hospitals. The major vehicle for achieving this goal is the Hospital Compare website.
http://www.cms.hhs.gov/HospitalQualityInits/25_HospitalCompare.asp

ICERx
Doctors and pharmacists caring for disaster victims can now obtain medication histories through a new Web service. The service is named ICERx.org, which is shorthand for In Case of Emergency Prescription Database, makes permanent the type of service cobbled together on short notice in 2005 after Hurricane Katrina wiped out thousands of personal medical records and many of the local drug stores that filled prescriptions.
Article:  http://govhealthit.com/article102890-06-04-07-Web&printLayout
Web site: http://www.icerx.org/

Tennessee's Office of the Inspector General wants to be sure medical professionals know about new legislation designed to reduce TennCare drug fraud. So the state OIG just sent out letters to more than 30,000 doctors, pharmacists and nurses educating them on the details of a new law designed to cut down on patient "doctor shopping"
Article in Memphis Business Journal: http://www.bizjournals.com/memphis/stories/2007/07/23/daily22.html?surround=lfn

Pennsylvania Gov. Edward G. Rendell (D) will sign a bill today expanding the permitted scope of practice for the state's nurse practitioners. The new law will allow nurse practitioners to perform new functions, including ordering wheelchairs, treating chronically ill patients in their homes and referring patients to specialists like occupational therapists. The new law also will give other professionals new powers; for example, certified midwives will get prescribing powers, and dental hygienists will be allowed to clean teeth without direct dentist supervision.
Article at philly.com:
http://www.philly.com/philly/health_and_science/20070720_Pa__law_expands_
job_scope_of_nurses.html

A Texas judge has issued an order which will reveal the identity of a blogger criticizing a hospital.
Computerworld article:
http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9026298&pageNumber=1

Nevada has passed a new law which requires hospitals to submit quality and cost information to state officials. The information, which will include average lengths of stay and average charges for the top 50 diagnoses, will be posted on a Web site by 2009
Las Vegas Sun Times Article
http://www.lasvegassun.com/sunbin/stories/text/2007/jul/02/070210883.html

The West Virginia Supreme Court of Appeals ruled that pharmaceutical companies  can be held partially liable for harm caused by drugs (in this case Janssen/Propulsid), despite the fact that physicians with medical expertise prescribe the drugs.
Healthdecisions.org article
http://www.healthdecisions.org/News/default.aspx?doc_id=124492

Publix chain offers free antibiotics
Publix supermarket chain said that it will make seven common prescription antibiotics available for free, joining other major retailers in trying to lure customers to their stores with cheap medications.
Article in the Sun Sentinel: http://www.sun-sentinel.com/business/orl-bk-publix080607,0,4203461.story

Infection Control

Needleless Systems
In the past year or so, there have been reports of increased bloodstream infections involving various needleless systems.  There has also been evidence to suggest that the newer positive fluid displacement luer-activated devices have produced an increase in catheter-related bloodstream infection rates.  Marcia Ryder, a well known researcher in biofilm-related infections, has recently completed a study comparing bacterial transfer from the surface of the connector to injected fluids for various devices on the market.  Her research has shown that bacteria contaminating the surface of a connector will appear in the fluid flushed through the connector.  She also identified significant differences in flush counts among the different connector systems.  She found that devices with the lowest bacterial counts tended to be in the split septum/inner cannula design as compared to the mechanical valve/open flow path systems. 

Hospital Acquired Infections
On July 27, the New York Times ran an article describing how a hospital successfully cut the rate of HAI’s in 40 bed surgical unit by conducting active surveillance on every arriving patient.  This practice, coupled with early isolation of contaminated patients, vigilant attention to hand hygiene and use alcohol hand sanitizers and use of disposable products like BP cuffs.  Several European countries, such as the Netherlands and Sweden, have all but eliminated MRSA through aggressive campaigns such as this, but most American hospitals find that they are too costly.  The hospital mentioned above determined that the cost of their infection control program, which included the cost of the test kits, the extra FTE’s needed for implementation, and the PPE expenses (estimated at $175/day/patient) was able to realize a net savings as the number of infected patients fell.

Premier, the national GPO, recently conducted a survey among 150 infection control specialists that concluded that automated surveillance systems can protect patients from HAI’s.  However, only about 13% of the responding hospitals actually used such a system.  However, there is move in health care towards zero tolerance policies in terms of HAI’s.  It costs about $20,000-50,000 to treat patients with HAI’s and the reimbursement is rapidly declining.  These systems would automatically link lab data, pharmacy data, and patient information.  The cost of these systems can be anywhere between $100,000--$300,000.

In the April 2007 edition of Materials Management in Health Care, Chris Wilkerson from Equipsystems discussed the failure of most hospitals in disinfecting hospital furniture, such as stretchers, over bed tables and recliners.  His organization conducted an independent study to determine the amount of bacteria, viruses and fungus on noncritical equipment surfaces both before and after cleaning.  VRE and other MDRO were found on this equipment even after cleaning.  Infection control processes as they relate to surface disinfection need to be implemented and monitored more effectively in hospitals.

APIC MRSA Prevalence Study
APIC’s National MRSA Prevalence Study is the largest, most comprehensive study of its kind.  This year’s survey response reflected 21% of all acute care facilities in the US.  Data showed that 46 out of every 1000 patients were either infected or colonized with MRSA; the total number of patients with detailed data were 7,944 patients.  77% of those with MRSA were identified within 48 hours of admission, which indicates that 35 out of every 46 MRSA patients is being identified quickly either by active surveillance or clinical diagnosis.  It also means that the majority of these patients are coming in with CA-MRSA.  Since only about 21% of the hospitals surveyed are doing active surveillance, this number can be projected to be much higher since many more colonized patients would be identified within this time frame.

Sources
Healthcare Purchasing News:  Newswire.  Aug 2007: 8.
Ryder, Marica.  “Needle-Free Devices as they relate to catheter-related blood stream infections.”  Presentation made to South Florida Chapter of INS; June 12, 2007.
Sack, Kevin.  “Swabs in hand, hospital cuts deadly infections”.  New York Times:  7/27/07
Joch, Alan.  “Automating infection surveillance efforts.  Materials Management in Health Care: 5/07: 17-19.
Wilkerson, Chris.  “Better maintenance of rolling stock affects infection control, bottom line.”  Materials Management in Health Care: 5/07: 52.

Quality / Medication Errors / Safety Issues

 “Joint Commission- New National Patient Safety Goals 2008” www.jointcommission.org

In the 6th annual issuance of the goals, major changes included:
• A new requirement to take specific actions to reduce the risks of patient harm associated with anticoagulant therapy
• A new goal that addresses the recognition of and response to unexpected deterioration of a patient’s condition.
Each of the new requirements have a one-year phase in period with full implementation targeted for January 2009.

The requirement related to hand hygiene has been expanded to permit use of the WHO (World Health Organization) guidelines as an alternative to CDC guidelines.

Healthcare Purchasing News, August 2007, pg. 6, www.hyonline.com
“Infection Control: Preemie dies of infection in NICU”
A 2 week old premature baby died from exposure to Serratia in a NICU at Mount Sinai Hospital, Toronto, Canada and four more babies tested positive for the bacterium.

The death closed the 34-bed NICU indefinitely and the surviving babies were put in isolation. Infection Control procedures in the unit were stepped up to include improved hand hygiene and wearing gowns and gloves. The hospital believes overcrowding and the aging infrastructure of the NICU, which was built in the 1970s, caused the bacteria to spread.

Materials Management in Healthcare, July 2007, pg. 5, www.matmanmag.com
“Drawing the Line on Central Line Infections”
It was reported in December 2006, that 28,000 deaths occur annually in ICUs due to central line infections. The Institute for Healthcare Improvements reports costs per bloodstream infection range from $3,700.00 to $29,000.00 and estimates ICUs log 15 million central venous catheter days per year. To significantly reduce the number of infections and thus the number of deaths, strict adherence to some simple behaviors and shifts in thinking about team member responsibility and limits.
A set of 5 interventions were used:
• Hand Washing
• Full barrier precautions during central line insertion
• Cleaning the site with chlorahexidine
• Avoiding femoral placement
• Removing unneeded catheters as soon as possible.

When these protocols were followed, and for 18 months thereafter, there was a 66% drop in total number of central line blood stream infections.

UPN Issues / Data Standards Issues

Healthcare Supply Chain Standards Coalition (HSCSC)
There are many challenges facing implementing standards. At this stage we don’t have just one pool to pull data from.  The data pools are multiple and this complicates the process.  Manufacturers have been very slow to move. The HSCSC, CHeS, and AHRMM have been vying for PDU but the manufacturers are heavily invested in the HIN and bar codes.  Very few customers are asking for these standards, which means less motivation for manufacturers to implement the standards.  Since no distributors or customers are asking for the implementation of these standards the manufacturers are reluctant to comply. Distributors are heavily involved with HIBCC, customers are referred to using the HIN and they are reliant on bar codes.  Distributors’ two main customers are hospitals and manufacturers and since they are not asking for these standards, distributors are reluctant to comply.  Owens and Minor has just signed on with HSCSC so their numbers are slowly rising.  The group is encouraging HIDA to get involved as well.  AHRMM contacted Matt Rowan, the executive director of HIDA and he agreed to meet regarding standards. Providers do not seem too concerned with the issue of Supply Chain Standards.  It is not even on most of their radar screens.  CFOs and CEOs will have to pay to clean their item master and will have to pay to implement these new standards.  Owens and Minor has just signed on with HSCSC so their numbers are slowly rising.  The group is encouraging HIDA to get involved as well. 

The FDA is close to a decision on a standard, either an IDN or PDU that will be GDSN compliant.  Hopefully the decision will be made by October. The AHRMM staff worked with the AHA to send a letter to the FDA regarding the determination of clinical attributes and to request that AHRMM be recruited to help to get the message out and increase awareness of this new standard.  By implementing a PDU with set clinical attributes the issue can have more weight as a safety issue and will therefore have more backing from other departments including nursing, environmental services, and facilities management.  The clinical attributes are not only available in the PDU, but eventually can be downloaded into the item master currently in the hospital and will have authoritative data from the manufacturer.  The FDA is limited in what they are able to ask for.  By engaging others such as OSHA and TJC we may be able to request more data. Other countries are calling for a lot more attributes for the product identifier.  Many of these countries are tying in more than products than we are. 

There are two working groups that are very active outside the HSCSC.  There is a full data synchronization pilot program with hospitals like Mayo, Miami Baptist, University Hospital.  They are getting data from manufacturers, manufacturers are putting it into one location and this information is being imported to the hospital’s MMIS system.  They are examining what issues arise, what problems they are having and what needs to be done differently.  The group will then prepare a White Paper on what it takes from each member of the supply chain to put this data in.