Issues & Legislative Committee

September 10, 2009

JCAHO / GPO Oversight Committee

Senators investigating seven GPOs

U.S. Senators from several committees, including finance, judiciary, and aging, are investigating the practices of group purchasing organizations. Concerned that GPOs may be inflating health costs at the expense of taxpayers, senators sent letters to the seven GPOs demanding detailed information about their business practices, including how they are paid, what services they perform besides picking brands and negotiating prices, and how their revenues are affected when an affiliated hospital buys supplies on its own instead of using the group contract. The senators also asked for copies of contracts. Senators Herb Kohl, chairman of both the Special Committee on Aging and the Judiciary Committee’s antitrust subcommittee; Charles E. Grassley of Iowa, the senior Republican on the Finance Committee and a member of the antitrust subcommittee; and Bill Nelson, a Florida Democrat on the Finance and Aging committees, all signed the letter. MedAssets (Alpharetta, GA), Premier Inc (Charlotte, NC), Novation (Irving, TX), Consorta (Schaumberg, IL), Broadlane (Dallas, TX), Amerinet (St. Louis, MO), and HealthTrust Purchasing Group (Brentwood, TN) all declined to comment on the senators’ action, referring inquiries to the Heath Industry Group Purchasing Association (HIGPA) (Chicago, IL).

HPN 8/14/09

Quality / Medication Errors / Safety Issues

Safety:
“Inattentional blindness: What captures your attention?”
ISMP Nurse Advise – ERR  August 2009 Vol. 7 Issue 8

Inattentional blindness is failure to see an object because your attention is not focused on it. Examples include a nurse reaches into a refrigerator for a piggyback antibiotic – she reads the label, spikes the bag with IV tubing, and administers the medication. The patient receives a neuromuscular blocking agent instead of the intended antibiotic and dies. Another example – a pharmacy technician labels and delivers an IV infusion to the dialysis unit. The nurse reads the label and hangs the bag while preparing her patient for dialysis. The patient receives sterile water for injection IV instead of 0.9% sodium chloride and dies.

The person performing these tasks fails to see what should have been plainly visible and later they cannot explain the lapse. In many cases, people involved in these errors have been identified as careless and negligent. But these types of errors are common – the cause is usually rooted in inattentional blindness – a condition all people experience at some point in time. So even thought the person reads the label, they see what they believe to be true and miss what is actually in print.

Accidents happen when attention mistakenly filters away important information and the brain fills in the gaps with what is aptly referred to as a “grand illusion”.

What captures your attention? Visual attentiveness is shaped by four factors:
1. Conspicuity – the degree to which an object or piece of information jumps out to capture your attention.
2. mental workload and task interference – Inattentional blindness is more likely to occur if part of your attention is diverted to secondary tasks, like answering the phone.
3. expectation – has a powerful effect on our ability to pay attention and notice information.
4. capacity – the capacity to pay attention is variable from person to person and influenced by age and mental aptitude.

It is difficult to reduce the risk of inattentional blindness as it is involuntary and unnoticed consequences of our adaptive ability to defend against information overload. Error-reduction strategies such as education, training, and rules are of little value. Efforts should center on increasing conspicuity of critical information and decreasing diversion of attention and secondary tasks when carrying out complex tasks.

FDA Reviews / Government Updates

The Congressional recess started and ends with no Health Care Reform legislation signed into law. What the President will say on Wed 9/9/09 to the joint session of Congress is not public.  I will upload a copy of the speech when available.

Summary from the Wall Street Journal:
Two overarching problems:
1. Convincing those who already have healthcare insurance that there’s something in Reform for them
2. COST!: the Congressional Budget Office estimates costs @ 1.6 Trillion over the next Ten (10) years                                   

Summary from the New York Times:
Two gargantuan tasks:
1. Expanding coverage
2. Reining in spiraling costs

Areas of agreement include: no insurance rules to exclude anyone.  All insurers to offer a minimum package benefits; federal subsidies for modest income people; health insurance exchanges; reward high quality care (outcomes) not volume (piece work).

Areas of disagreement include: employer mandates; a publicly run health plan.
Employer and business groups are advocating change in 2009 due to soaring costs. This was not the case in 1993-94.

Electronic Health Record (EHR):
Two Fed Gov’t Departments - DOD and the Dept of Veterans Affairs (DVA) have independently developed EHRs!  (AHLTA & VISTA respectively) They don’t talk to each other!  The ultimate goal is to create a record for individuals the first day they join the military and maintain it though the individual’s lifetime.  No mention of private sector use post military. http://veterans.house.gov/hearings

HealthCare Finance News:  Aug 2009
White House Secures AHA’s Backing

There is a “framework” for reimbursement concessions for hospitals  to avoid spending $155 billion in Medicare and Medicaid over the next ten years.  Besides AHA, Catholic Health Assoc and the Federation of American Hospitals said they support proposals to set restrictions on physician self-referrals to hospitals where they have an ownership interest and simplify red tape.

From Materials Management in HealthCare  Sept 09
America’s nurses believe they spend too much time on supply chain activities fearing that it would not be done correctly otherwise! Examples include: searching for supplies; putting away supplies; managing expiration dates nod lot #s; Materials Managers should: Educate all staff about the supply chain; create a strategic plan for shared accountability; reallocate teams to align activities to skills; outsource as appropriate.

Senators Probe GPOs:
Senators have asked the seven largest GPOs to provide data on: how they are paid; what service they provide besides picking brands and negotiating prices; how their revenues are impacted when their hospitals buy outside the GPO contracts.

Pricing Forecast -- Cloudy:
After a volatile period, supply chain prices are stabilizing but continued economic pressures and possible health reform promise ot influence pricing.

Cost of Confidentiality (ECRI) / Transparency (AHRMM President Jay Kirkpatrick)
Hospitals have little or no access to data on what other hospital pay for the same devices. The major categories for physician personal preference items are cardiology and orthopedics. AHRMM believes that transparency would expose waste, greed and inefficiency cutting prices 20-50%!

Rules for OR Reps
Currently each Medical center has its own rules and policies.  The effort for national standards has been moving slowly.  Many private sector firms offering software and policies have sprung up.

Joint Commission bows out of vendor credentialing debate.
JCHAO announced that it is not in the business of developing standards of competence for healthcare industry sales reps.  (Journal of Healthcare Contracting July/Aug pg 6

FDA:
The recalls start once again with Peanuts.  Drugs include 2 million bottles of Listerine, as well as 20 pages of Smith and Nephew Bone healing systems serial numbers. http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm180348.htm