2013 WILL BE THE YEAR OF ACCOUNTABILITY

Earlier this month I stated my prediction that hospitals will be held accountable for their actions, and suffer consequences that will affect their bottom line if they do not perform up to specific sets of standards.
So, how will hospitals be held accountable for outcomes? In 2013 and beyond, hospitals will have their feet to the fire through a process and outcome measurements (Hospital Safety Score), which is now and will continue to be published in the news as well as on the internet, including letter grades for each hospital. I believe this will affect not only the bottom line for hospitals and their medical staff, but the hospital pharmacy and staff as well.

Briefly, the Hospital Safety Score grades general acute care hospitals on how safe they are for patients. The grades are determined from publicly available data from the Centers for Medicare and Medicaid Services (CMS), The Leapfrog Hospital Survey (published by The Leapfrog Group, a national not-for-profit organization founded by the nation's leading employers, including behemoths such as General Motors and FedEx, and private healthcare purchasers). The Leapfrog Group's aim is to enhance the safety, quality, and affordability of healthcare in the U.S. by promoting transparency and value-based hospital incentives. The Leapfrog Survey is considered to be a trusted, transparent, and evidence-based national tool that more than 1100 hospitals voluntarily participate in free of charge.

The Hospital Safety Score is based on 26 measures*, including Computerized Physician Order Entry (CPOE). However, scanning meds at bedside is not listed among the 25 measures, although, in my opinion, scanning meds at bedside is more effective than CPOE in reducing med errors.

Leapfrog is serious about its grading. The grades are calculated under the guidance of a 9-member panel of patient safety experts. Among the 25 hospitals receiving an F for Safety in Fall 2012 include the University of California Ronald Reagan UCLA Medical Center, as well as three additional hospitals in California, 5 hospitals in Illinois (including three in Chicago), and 5 in Texas.

MEDICARE PAYMENTS ALSO TIED TO ACCOUNTABILITYIn 2013 Medicare funding will also be tied to how well hospitals perform. A recent article in The Columbus Dispatch (December 22, 2012), stated that the federal government released new data that base nearly $1 billion in Medicare payments to U.S. hospitals next year on their performance. The data show how much hospitals stand to gain or lose -- as much as 1 percent in Medicare reimbursement -- based how well they follow 12 clinical standards of care and score on certain patient-satisfaction criteria.

It's reasonable to conclude that, if hospitals lose funding based on poor grades, we all will suffer, including patients, physicians and medical staff -- and pharmacists who serve at these hospitals.

Fortunately, we have it in our power to ensure good grades by delivering the utmost in care to all patients at all level of service. And as always, you can be assured that Shamrock Medical is at your side, ready to help the hospital community with drug repackaging to ensure the safety of your patients' medication needs, which will certainly help raise the safety standards of every healthcare institution we serve.

*All 26 measures include 15 process and structural measures and 11 outcome measures, including foreign object retained; air embolism, pressure ulcer-stages 3 and 4; falls and trauma; death among surgical inpatients; post-op respiratory failure, to name a few.
 
Here's to better solutions,

Dave Bystrom

WHAT WILL THE NEW YEAR BRING?

Unfortunately, I don't have the gift of prognostication, but I can safely predict that in 2013 hospitals and health care institutions will continue to be held accountable for the health and welfare of patients.

The pressure will continue to be placed on hospitals to improve quality and safety, and CMS (Centers for Medicare and Medicaid Services) will continue to place incentives and penalties for hospital outcomes.

During the month of January I will explore two topics. The first, discussed in this post, will be Meaningful Use, which describes the incentives for hospitals and physicians to develop the Electronic Medical Record (EMR), which includes 15 core criteria. Note that CPOE (computerized physician order entry) is included, but scanning of medications at the bedside is not. I, and many hospital pharmacists, agree that while this is not mandated, bedside scanning of meds is becoming highly valued in the field. This government sponsored EMR program doesn’t place enough emphasis on medication safety, or it would mandate bedside scanning. If we focus on med safety; scanning is less expensive and more effective than CPOE.

While the pharmacy staff may not be directly affected by much of this, we can all generally agree that hospital pharmacists should be aware of incentives/penalties, and the impact of making this public. In the pharmacy, we are (and should be) very focused on medication safety. But as we go into 2013 and beyond, it appears that electronic medical records, readmission rates, patient satisfaction surveys, and now some clinical measurements, are of utmost importance to our government and to the general population. In fact, to some degree, the focus on EMR gives us some lead time, so that when the U.S. government does begin counting medication errors, pharmacies will already be heavily invested in the process.

The second topic, which I plan to discuss mid-month, is the process and outcome measurements (hospital safety scores) being published in the news as well as on the internet, including letter grades for each hospital. The pressure is on improving quality, with incentives for success. Nothing wrong with that. The onus will remain on hospitals to be transparent and honest in their practices and reporting. 

MEANINGFUL USE

Simply put, Meaningful Use is a government program that encourages medical providers to adopt and use an Electronic Health Record (EHR). Incentive funds are utilized to help doctors implement and make the transition. To receive payments, physicians must demonstrate a set of 20 Meaningful Use criteria for effective EHR adoption. Any physician who sees Medicare or Medicaid patients may be eligible for Meaningful Use incentives.

Meaningful Use is overseen by HITECH (Health Information Technology for Economic and Clinical Health Act), CMS (Center for Medicare and Medicaid Services), and ONC (Office of the National Coordinator for Health Information Technology.

Meaningful Use includes 15 core criteria and 10 additional measures, of which a physician must choose five. Of interest to pharmacists would be four of the 15 core criteria, which includes Active Medication List; Medication Allergies; Hospital Discharge Instructions and Drug-Drug and Drug-Allergy Interactions.

We hospital pharmacists tend to believe the world revolves around meds and med errors, but as the parameters for Meaningful Use exhibit, they aren't exactly the number one priority at the moment. Unfortunately, the opportunity for a med error is much greater than the opportunity for a sponge to be left in a patient post surgery. But, as we enter 2013, let's maintain the momentum toward 100% scanning at the bedside. It is the most effective medication safety tool, and be assured that Shamrock Medical Solutions Group stands ready to support your efforts.

Here's to better solutions, 

Dave Bystrom