Issues & Legislative Committee Report

October 12, 2006

JCAHO/Gainsharing Update

Gainsharing Agreements  

The Centers for Medicare and Medicaid Services (CMS) are seeking applications for a Medicare hospital gainsharing demonstration-an agreement between a hospital and physicians to share in the benefits of reducing health care costs. Six hospitals and their participating physicians will be selected for the pilot projects ("DRA 5007"), which will focus on the short-term impacts of these types of agreements; two of the hospitals must be rural. Applications are due Nov. 17.

The Project name is DRA 5007 Medicare Hospital Gainsharing Demonstration. This demonstration will examine the effects of gainsharing aimed at improving the quality of care in a health delivery system. More specifically, the demonstration will determine if gainsharing is an effective means of aligning financial incentives to enhance quality and efficiency of care. This is a three-year project beginning January 2007 and ending December 2009.

Six project sites to be selected, two have to be rural. Selected sites must demonstrate that its proposal will produce improved quality care and delivery of health care services to Medicare beneficiaries.

Sources:
http://www.aamc.org/newsroom/ 
http://www.cms.hhs.gov/DemoProjectsEvalRpts/

The Joint Commission (JCAHO)

The Joint Commission announced a partnership with major infection control leadership organizations in the United States and abroad to identify best approaches for measuring compliance with hand hygiene guidelines in health care organizations. Lack of consensus on how to measure hand hygiene compliance has made it difficult for epidemiologists, infection control practitioners, and quality improvement professionals to determine the effectiveness of hand hygiene expectations across various health care settings. The final product of this project will be an educational monograph that recommends best practices for measuring hand hygiene compliance.

The Joint Commission urges hospitals to pay special attention to how emergency power systems can fail and recommends specific steps to keep patients safe in the event of a disaster or other major event that knocks out the organization’s electrical power supply. Reports from the 2001 floods in Houston, the 2003 blackout in the Northeast, and hurricanes that have hammered the Southeast over the past two years show how severely clinical operations can be affected in health care organizations that lose their electrical power. This is in the form of a Sentinel Event Alert that brings the reality of these risks to the attention of the nation’s health care organizations, and offers practical solutions to avoiding adverse patient care events in the event of electrical power failure.

Source: http://www.jointcommission.org

Ethics/Pharmaceutical and Vendor Gifts

In August 2006, the LA Times reported that Congress has asked the director of the National Institute of Health to investigate a senior researcher’s ties to pharmaceutical companies and further assess its conflict of interest guidelines. The physician in question has led clinical trials to treat fungal infections in immunocompromised patients. There had been questions raised regarding two of the past clinical trials in which other scientists questioned the adequacy of the control drug dosing. Two of the companies have acknowledged that this researcher has received fees from them in recent years. He has also appeared with these companies at various FDA meetings held to discuss these antifungal agents. U.S. conflict of interest law generally prohibits a federal employee from representing an outside party before a
government agency.

On September 12, 2006, the Associated Press observed that the majority of federal scientists who are investigated for accepting improper payments from drug or biotech companies rarely receive serious punishment. Often, they receive written or verbal reprimands for failing to disclose outside work; in some cases in which serious allegations of impropriety have been made, the scientist remains on the NIH payroll.  Following the "LA Times" investigation, 44 of the 103 employees investigated by the NIH had been found to have violated ethics rules. Half of these received written or verbal reprimands, and many of the others received no penalties.

On September 11, 2006, "The Washington Post" reported on concerns voiced by Congress that federal health agencies were too lenient with government officials who have violated ethics laws. There have been occasions in which scientists have received up to $700,000 in illegal consulting fees, and these scientists remain employed the federal agencies. It is difficult to fire anyone from the Public Health Service’s Commissioned Corp, to which these scientists belong. Even in the case of egregious wrongdoing, formal corps hearings must be held before this can happen, and in several cases these have been postponed indefinitely at the request of the Justice Department, who may pursue criminal charges.

"HPN News" reports on the latest Conflict-of-Interest Notification Study, which was published in the Fall 2006 issue of Journal of Law, Medicine and Ethics. It discusses the reluctance of researchers and other agency officials in fully disclosing financial conflict of interest to clinical research participants. This publication, which reflects the attitudes and beliefs of institutional review board members, reveals a belief by researchers that participants in these studies might lack the sophistication to put these potential conflicts of interests in context, causing them to decline from participating in these research studies. While all agree that such conflict of interest situations should be revealed to study participants, there is no consensus regarding the level of detail necessary.

Hospitals for a Healthy Environment (H2E)

The September issue of "Materials Management In Health Care" magazine's cover story is about how hospitals are pushing vendors toward "Green Purchasing". The article is informative and points out some ecological helpful hints.