The Partnership for Patients and the Aging Network

Message from the Assistant Secretary for Aging Kathy Greenlee

Today, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national public-private partnership with the goals of:

* Keeping patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 

* Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

Through the Community-based Care Transition Program, HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help people with Medicare safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits. In addition, in coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. 

The aging network – state and local organizations alike -- has a vital role to play in this effort to integrate medical and long-term supports and services and improve care transitions for our clients and their families.  This work also provide an excellent opportunity to integrate other important work you are already doing – including Aging and Disability Resource Centers, benefits outreach and enrollment, caregiving and respite programs, chronic disease self-management and other health promotion/disease prevention programs, and more.  Finally, the partnerships that you build through care transitions work – with hospitals, physician practices, long-term care facilities and other organizations – can also help to position you better for future ACA-related opportunities such as accountable care organizations, health homes, patient-centered medical homes, and more.

Here is how we can work together on this initiative:

* Learn more about the Partnership for Patients and join the partnership by visiting the Partnership website at http://www.healthcare.gov/center/programs/partnership 

* Read our special Affordable Care Act Newsletter which provides you with additional details about the Partnership for Patients and the Community-based Care Transition Program (CCTP).  To access the newsletter, please go to  http://www.aoa.gov/Aging_Statistics/docs/ACA_Enews_P4P_041211.pdf 

* Join us for our next Webinar on Wednesday, April 20, which will offer an overview of the CCTP solicitation, and the opportunities for the aging network that lie within.  (Watch your email for registration details)    

Medicaid Program-Payment Adjustment for Provider-Preventable Conditions Including Health Care-Acquired Conditions

This proposed rule would implement section 2702 of the Patient Protection and Affordable Care Act of 2010 which directs the Secretary of Health and Human Services to issue Medicaid regulations effective as of July 1, 2011 prohibiting Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care-acquired conditions. It would also authorize States to identify other provider-preventable conditions for which Medicaid payment would be prohibited.

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on March 18, 2011.

Full Federal Register Notice

Partnership Takes Aim At Preventable Hospital Readmissions Among High-Risk Seniors

SCAN Health Plan and Lakewood IPA have partnered with Dovetail Health in a program designed to reduce readmission rates for high-risk seniors following discharge from hospitals and skilled nursing facilities.

Under the new program, high-risk SCAN Health Plan members in Southern California whose primary care physicians are part of Lakewood IPA are now being referred into Lakewood's "Healthy Transitions" program upon discharge. Led by Dovetail, the Healthy Transitions program combines elements of existing transition management programs - such as improved discharge planning and telephonic case management - with a unique focus on medication optimization and adherence.

"We believe that this program will lessen the number of seniors readmitted to a hospital for reasons that are totally avoidable," said Timothy Schwab, MD, chief medical officer for the not-for-profit SCAN Health Plan. "By focusing on those problems most commonly found and tailoring the program to each individual, we can make a significant, positive impact in the lives of many of our members."

In general, patients enrolled in the program take an average of 12 medications and have chronic conditions such as diabetes, chronic obstructive pulmonary disease, congestive heart failure and renal disease. More than 75 percent are at increased risk of falls. One in five seniors nationwide is readmitted within 30 days of discharge at a staggering cost of over $17 billion, and medication-related issues are frequently a factor.

The Healthy Transitions program sends pharmacists to meet patients in their homes following discharge from hospitals and skilled nursing facilities. Healthy Transitions pharmacists review every prescription and over-the-counter medication. During the visits they clarify orders, educate patients and caregivers, identify opportunities to optimize medication schedules, and address issues such as non-adherence. Easy-to-read reports are printed for patients, and a version is prepared for their physicians with key questions or issues highlighted.

In addition to medication counseling and support, the Healthy Transitions program follows patients for 30 days to provide ongoing guidance around chronic illnesses, safety, advance-care planning and other potential readmission risk factors. At the end of 30 days, patients are referred back into the appropriate care-management programs at SCAN or Lakewood IPA.

"Our patients have been very open to having the home visit. The comprehensive counseling, support and assessment from the pharmacist are an asset to the physician and the case managers in the continued coordination of care for these high-risk members," said Robin Tufono, director of outreach programs at Coast.

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Interruptions Risk Medication Errors by Nurses from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

When nurses are interrupted while administering medication, the risk of procedural failure and clinical error increases, data from an Australian study showed.

Such interruptions occurred more than half of the time, and three during the same drug administration led to a procedural failure rate of 85% and a clinical error rate of almost 40%, according to a study reported in the April 26 issue of Archives of Internal Medicine.
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• Interrupting a Nurse Makes Medication Errors More Likely (nlm.nih.gov)

ADVERSE EVENTS IN HOSPITALS: METHODS FOR IDENTIFYING EVENTS

OBJECTIVE To evaluate the usefulness of selected methods for identifying events that harm hospitalized Medicare beneficiaries.

BACKGROUND
The term “adverse event” describes harm to a patient as a result of medical care or harm that occurs in a health care setting. The term “never events” refers to a specific list of serious events, such as surgery on the wrong patient, that the National Quality Forum deemed “should never occur in a healthcare setting.” The Tax Relief and Health Care Act of 2006 (the Act) mandated that the Office of Inspector General (OIG) report to Congress about such events, including making recommendations about processes for identifying events. To meet the requirements of the Act, OIG published a series of reports in 2008 and will publish additional reports based on ongoing work.

In 2008, OIG conducted a case study to determine the incidence of adverse events (hereinafter referred to as events) by reviewing a random sample of 278 Medicare beneficiary hospitalizations selected from all Medicare discharges from acute care hospitals in two selected counties during a 1-week period in August 2008. Using a two-stage review process, the case study identified 120 events. The first stage consisted of using five selected methods to screen for events, including nurse reviews of medical records, interviews of Medicare beneficiaries, two types of billing data analysis, and reviews of internal hospital incident reports. Each time a screening method indicated the possibility that an event occurred during the hospitalization, researchers designated the possible event as a “flag.” The second stage consisted of physician reviews of medical records for 183 of the 278 beneficiary hospitalizations—those with at least 1 flag. This report provides an indepth examination of the usefulness of the five screening methods used for identifying events. OIG considered the most useful methods to be those that identified the greatest number of events.
Read/Download Report

Proposed Bill Wants Medical Mishaps To Be Reported By State Hospitals - Courant.com

By MATTHEW KAUFFMAN

All medical mishaps reported by state hospitals would again be made public under legislation to be considered this session by the public health committee.

The proposed bill, drafted by the attorney general's office, would eliminate a confidentiality provision added in 2004 to the state's "adverse event" law; a revision that now keeps most reports secret. The draft also calls on the state Department of Public Health to conduct random audits of hospitals to determine compliance with the reporting law, with each violation bringing a fine as high as $10,000.
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• When the Law Allows Hospital Errors to Remain Secret (blogs.wsj.com)

Murtha's procedure rarely deadly

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from AARP Bulletin Today

(CNN) -- Taking out a patient's gallbladder is routine. At least 500,000 such surgeries are done each year in the United States. It takes an hour or two, and the patient can go home that day or the next.

But in rare cases, the surgery can be deadly. Democratic Rep. John Murtha of Pennsylvania recently died after complications from the procedure after doctors "hit his intestines" during surgery, a source close to the late congressman told CNN.

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• Rep. John Murtha From Pennsylvania Dies - Intestine Was Accidentally Damaged in Surgery (ducknetweb.blogspot.com)
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• Congressman: Murtha's intestine damaged in surgery (seattletimes.nwsource.com)

Award Winning Author and Patient Advocate Releases "The Patient Safety Checklist" to Prevent Medical Errors in Hospitals

Surgical safety checklists have been shown to be very effective in significantly reducing fatal medical errors when used by surgeons and members of the surgical team. (See Harvard study.) Martine Ehrenclou, author of the multiple award winning book, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive, has created "The Patient Safety Checklist" for patients and their advocates to further close the gap on preventing medical errors in hospitals.

Ehrenclou created "The Patient Safety Checklist" for hospitalized patients and their family members to work together with the medical professionals in increasing the likelihood that a hospitalized patient will not fall victim to deadly medical errors. "A collaborative effort is needed," states Ehrenclou. "With the pressure physicians and nurses are currently under, patients and their family members must get involved in the hospitalized patient's medical care."

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Not on My Watch Campaign To Eliminate Hospital Acquired Infections

Health Business Blog » Podcast interview with Dr. Robert Wachter and Dr. Arpana Vidyarthi: Part 1

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by David E. Williams of the Health business blog

Patient safety pioneer Dr. Robert Wachter is Chief of the Medical Service at UCSF Medical Center and Dr. Arpana Vidyarthi is Director of Quality. They have recently re-engineered UCSF’s medical peer review process and adopted an electronic platform from Acesis to make the process faster, safer and more objective.

In Part I of our podcast interview, Vidyarthi and Wachter provide an overview of the traditional process and discuss their progress in shifting to a new, technology-enabled process. They discuss key principles of their approach, along with the relationship between culture and technology.

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Patient safety surveillance: keeping watch in hospitals, from sinks to surgery

Maryland gets federal stimulus funds for "secret shoppers" to monitor health professionals' hand hygiene. A Rhode Island hospital will videotape surgeries. Some worry about Big Brother.

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Medical News: Surgical Mistakes Continue Despite VA Initiative - in Surgery, General Surgery from MedPage Today

Image by Digital Magic Photography via Flickr

By Nancy Walsh, Contributing Writer, MedPage Today

Despite a concerted effort to reduce them, surgical mistakes, particularly errors in communication, continue to occur in the operating room and elsewhere in hospitals, a Veterans Health Administration study found.

A total of 342 events were reported to a national database between January 2001 and June 2006, 212 of which were actual adverse events and 130 of which were close calls, according to Julia Neily, RN, of the Department of Veterans Affairs in White River Junction, Vt.

A total of 108 (50.9%) of the adverse events occurred in the operating room and 104 (49.1%) occurred in other locations such as procedure rooms and radiology suites, the researchers reported in the November Archives of Surgery.
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AMNews: Oct. 12, 2009. Quality improvement tool available for doctors, hospitals ... American Medical News

By Kevin B. O'Reilly, AMNews staff

Physicians and hospitals are under increasing pressure to protect patients from harm. But of the many hospital process changes that could improve quality and safety, which ones should get priority? Which have the best evidence, will be most cost effective and easiest to implement?

The Institute for Healthcare Improvement, a Cambridge, Mass., nonprofit, in late September announced a free Web tool designed to make it easier for doctors, nurses, and quality and safety officials to answer those questions. The IHI Improvement Map, a user-friendly source for data on 70 quality and safety processes, is available at the organization's Web site (www.ihi.org/imap/tool/).
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Medical Malpractice Liability Cost - Health Blog - WSJ

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By Jacob Goldstein

As we’ve noted before, it’s tough to know just how much medical malpractice contributes to health-care spending. Not only do you have direct costs like malpractice premiums, you also have the harder-to-quantify indirect costs of defensive medicine, like extra tests doctors order out of fear of lawsuits.

But its the job of the number crunchers at CBO to put a number on that sort of thing, and they’ve just come out with their latest figures on the subject. Specifically, they estimated what would happen if there were a national cap on punitive and noneconomic damages as well as other new rules that could limit doctors’ liability exposure.

They found that such changes would lower the nation’s total health bill by about 0.5%, or $11 billion a year at current spending levels. That includes 0.2% in savings from lower direct spending on malpractice, and 0.3% in savings from “slightly less utilization” of health care as a result of less defensive medicine.
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Florida lawsuit takes swing at 3-strikes liability rule ... American Medical News

In some states, people convicted of three or more criminal acts get extra punishment after their third strike. In the Sunshine State, physicians face a so-called "three strikes and you're out" rule on medical liability judgments.

Florida voters borrowed the concept when they passed a constitutional amendment allowing doctors' licenses to be revoked if they had three medical liability judgments against them. The measure is believed to be the only one of its kind in the country.
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Hospitals Find Way to Make Care Cheaper -- Make It Better - WSJ.com

By THOMAS M. BURTON

Be it cereal or cars, buyers usually have an idea of how good the products are and how much they cost before they buy them.

That's not how U.S. health care works. Patients rarely know which hospitals offer top-quality lung or aortic surgery, and which are more likely to harm them. Hospitals don't compete on price and rarely publish measurements of their quality, if they measure it at all.

Except in Pennsylvania. For two decades, a state agency has published "medical outcomes" -- death and complication rates -- from more than 50 types of treatments and surgery at hospitals. The state has found that publishing results can prompt hospitals to improve, and that good medical treatment is often less expensive than bad care.
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Surgical Deaths Linked to Handling of Complications - Forbes.com

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Staffing and hospital culture play a role, expert contends

(HealthDay News) -- The way that a hospital handles the complications of surgery, not just the rate of those complications, determines the hospital's surgical death rate, a new study has found.

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• Vital Signs: A Study Looks at Deaths After Surgery (nytimes.com)
• Complications are not best predictor of hospital mortality (scienceblog.com)

AMNews: Sept. 30, 2009, 2009. Joint Commission opens center to develop patient safety solutions ... American Medical News

The Joint Commission has been accrediting hospitals since 1953, and in the last two decades stepped up efforts to identify issues that can harm patients, ranging from poorly deployed technology to disruptive behavior. The commission announced in September it will take a more hands-on approach, launching a center that will seek innovative patient-safety interventions.

The new Center for Transforming Healthcare, opened with $10 million in commission reserves, is working with eight hospitals and health systems on its premier project to identify and overcome barriers to 100% hand-hygiene compliance. The commission is teaming up with organizations such as Cedars-Sinai Health System in Los Angeles that already use industrial process-improvement techniques borrowed from Motorola and Toyota Motor Corp.

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AMNews: Sept. 28, 2009. Challenges to medical liability caps go before Georgia, Maryland high courts ... American Medical News

Doctors say the cases threaten to destabilize liability climates and highlight the need for tort reform to be part of federal health system reform.

High courts in Georgia and Maryland will decide the fate of caps on noneconomic damages in medical liability cases in each state, two of the latest attempts to undo such award limits.

The Georgia Supreme Court case stems from a February trial court decision rejecting the constitutionality of the state's $350,000 cap. Oral arguments began Sept. 15 in Atlanta Oculoplastic Surgery v. Nestlehutt.

Maryland's Court of Appeals is set to hear arguments Nov. 5 on whether the state's caps apply only to cases that are arbitrated.
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AMNews: Sept. 22, 2009, 2009. Apologizing for medical errors may not stop you from being sued ... American Medical News

By Damon Adams

Physicians who apologized and accepted responsibility for medical errors received better ratings and earned greater trust from patients than physicians who did not, a new study says. But such disclosures do not guarantee that patients won't still sue.

Researchers said their study in the September Journal of General Internal Medicine supports previous findings on apologies and disclosure of adverse events. But they were surprised to find that the patient's perception of what was said may be more important than what the physician actually said.

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