Supreme Court allows healthcare law to largely stand

The Supreme Court on Thursday largely let stand President Obama's health care overhaul, in a mixed ruling that Court observers were rushing to analyze. 

The decision was a striking victory for the president and Congressional Democrats, with a majority, including the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obama's term. 

Many observers called the case the most significant before the court since at least the 2000 Bush v. Gore ruling, which decided a presidential election. In addition to the political reverberations, the case helps set the rules for one of the largest and fastest-growing sectors of the economy, one that affects nearly everyone from cradle to grave. 

Read the rest of the NYT article. 

Read the ruling on the official SCOTUS website www.supremecourt.gov - under recent decisions. 

Go to the NYT Health Care Reform and the Supreme Court (Affordable Care Act) special page, which includes updates and audio files of the original case arguments.

Go to the WSJ health page.

Will pay-for-performance work for infection prevention?

Dr. Cindi Crosby - Vice President, Global Medical Affairs, CareFusion ___________________________________________________________________

The pay-for-performance (P4P) movement in the U.S. healthcare system is not new, but the Patient Protection and Affordable Care Act (PPACA) has the potential to usher in the largest federal expansion of P4P to date. A provision of PPACA mandates pilot testing of P4P for certain Medicare providers, beginning no later than January 1, 2016. Even if legal and political challenges result in the repeal of PPACA, momentum for P4P continues as insurance companies and healthcare systems strive to improve health outcomes and reduce costs.

Pros and Cons
Proponents of P4P focus on the logic behind providing incentives to healthcare organizations and providers to meet measurable process improvements or clinical outcomes, such as better management of chronic diseases or reducing infection rates. At first glance, these P4P objectives seem reasonable and desirable in terms of improving clinical outcomes. But detractors of P4P cite a number of problems, including the assumption that financial incentives (or disincentives tied to poor performance) will affect important clinical outcomes associated with morbidity and mortality. (See “Effect Of Pay For Performance On The Management And Outcomes Of Hypertension In The United Kingdom: Interrupted Time Series Study.”) A study published online in New England Journal of Medicine (March 28, 2012) found that hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID) had no decrease in 30-day mortality compared to control hospitals over a six-year period. The authors noted that P4P effects on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (i.e., acute myocardial infarction and CABG) and those not linked to incentives (i.e., congestive heart failure and pneumonia). (See “The Long-Term Effect of Premier Pay for Performance on Patient Outcomes.”) As expected, a quick scan of the medical literature shows an evolution from primarily positive articles in the early and mid-2000s, when P4P was a broad goal yet to be widely implemented, to more recent restrained views of actual P4P program outcomes.

Read the full story.
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Crosby’s work in CareFusion’s Medical Affairs Department represents the perfect culmination of a career that has always focused on combining education with research to improve patient care. From her start working in a bone marrow transplant unit at a university medical center to her recent honorary appointment as a research associate in infectious disease in the Department of Microbiology at Queen Elizabeth Hospital in the UK, Crosby’s primary focus has been the clinical application of infection control products to improve patient health outcomes. But Cindi has also always understood the importance of building networks to share information and solve problems. Her education and background as a microbiologist has helped her assemble effective global partnerships with key thought leaders in infection prevention, and she has built on this further by publishing and speaking to share information with those who care for patients.

If you wish to read more of Dr. Crosby’s blogs, then please visit: http://www.carefusion.com/safety-clinical-excellence/perspectives/infection_prevention.aspx.

SPD Professionals launch new blog: “Reprocess This!”

Three respected Sterile Processing managers today launched a new online forum for CS professionals, “Reprocess This!”  

The new blog (www.reprocessthis.com) was developed to create “a medium for sterile processing managers to network and discuss the hard-hitting issues that are facing the industry,” said Jennifer Burrell, BS, CRCST, CSPDM, one of the three SPD professionals writing regularly for the forum. 

Burrell, a microbiologist, is Director of Education and Clinical Compliance for IMS, the nationwide surgical instrument management and consulting provider that is hosting “Reprocess This!” IMS provides SPD management and clinical consulting in the OR, repair for surgical and endoscopic equipment, instrument and device inventory management; real-time online data and tools to track instruments, tissue, and implants.  

The other regular contributors are:

Tracy Humphreys, BS, MS, CRCST. Humphreys, CS Manager for Metro Health Hospital in Wyoming, MI, was selected as IAHCSMM’s CS Manager of the Year in 2011. With 13 years experience in SPD, she is active in national and state professional organizations. 

Kristina Pirollo-Ketchum, CRCST, CHL, ACE. Pirollo-Ketchum is Manager of SPD and Perioperative Surgical Services for MWHC Stafford Hospital in Stafford, VA. Her work has appeared in IAHCSMM Central Source, Healthcare Purchasing News, and IAHCSMM Communiqué.  

Although the three have different educational and professional backgrounds, they share a belief in Sterile Processing’s critical role in patient safety - and they are passionate about the need for continuing education in the SPD.   

“This blog is an an effort to raise the bar and help us all stay abreast of the latest and greatest technology,” Pirollo-Ketchum said. “Not only can we learn how others handle issues or concerns, but we can use the blog to keep up with changing standards. Knowledge is power.” 

Burrell said SPD professionals need an informal setting for the exchange of opinions and information. 

To visit this new online forum, go to www.reprocessthis.com

For more information about “Reprocess This!” write to info@reprocessthis.com

Is the FDA validation process for sterilizers, as established in AAMI ST8, current with today's steam sterilization practices?

HPN's most recent Blogline post comes from Thomas K. "Chip" Moore, consultant and owner of the Sterilization-Answer-Man.com. Retired from Getinge in 2007 after a 39-year career in sales and marketing, Moore has more than 20 years experience working on AAMI Committees and is active on selected Working Groups, was a member of the AAMI Sterilization Standards Committee, and is a member of IAHCSMM and the AORN Specialty Assembly for Sterile Processing. He also served as an Ex-Officio Board member for NYSACSP for three years. He was recipient of the 2003 IAHCSMM Award of Honor and was selected by Healthcare Purchasing News as one of the 30 most influential industry people. 

In his article, Moore examines the performance and validation standards set forth in Hospital Steam Sterilizer guidance document ANSI/AAMI ST8, and asks whether these test requirements are sufficiently robust, given today's mixed loads. 
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“If you happened to manage a company that manufactures sterilizers for use in US healthcare, what steps would you take to sell a steam sterilizer in the United States? The first step is to recognize that sterilizers are used to process reusable medical devices for patient use, and sterilizers are considered as Class II medical devices. Therefore, they are regulated by the Food and Drug Administration (FDA). Before any Class II device can be placed into commercial distribution, the FDA must grant clearance of the labeling claims for the sterilizer. Many of those labeling claims are developed through a process called performance validation. Fortunately, a guidance document exists to help the sterilizer manufacturer develop performance data to base those labeling claims. Once the FDA clears the sterilizer for US commercial distribution, the product is considered safe and effective when the user follows the written instructions for use (IFU).

 
The guidance document for healthcare sterilizers is a nationally recognized standard, developed through the consensus method at the Association of the Advancement of Medical Instrumentation (AAMI). The document is ANSI/AAMI ST8, the Hospital Steam Sterilizer guidance document. The ST8 committee updates the document every five years. The current ST8 document was published in 2008. Yet, does the performance and validation testing contained in ST8 reflect current healthcare sterilization practices? This article will attempt to review those performance challenges and compare them to practices found today in US healthcare facilities, both large and small.”

To read the entire article, visit
http://www.hpnonline.com/dailyupdates/Moore-SterilizationValidation.pdf


What's your reaction? We want to hear from you. Let us know your thoughts below.

Keeping trains and interoperability on track

Dr. Dick Johannes, Vice President of Clinical Research at CareFusion, discusses trends in operating room procedures and management, at CareFusion’s Online Center for Safety. ___________________________________________________________________

“Recently, on our way to a morning meeting, Dr. Carlos Nunez and I got to talking about model railroads – a mutual interest and hobby. We recounted the history of Digital Command Control [DCC] – a system that utilizes digital computer technology to operate model railroad trains. DCC was first introduced in the 1990s and dramatically changed model railroad technology: For the first time, when running multiple locomotives on the same track, you could move each train in different directions and at different speeds.

Similar to most technological breakthroughs, numerous manufacturers began engineering their own early and highly proprietary versions of Command Control for model railroads. While this brought the technology to the marketplace, it introduced a new problem for users as these early approaches were incompatible with one another. We could now run trains independently on a model railroad, but couldn’t take a locomotive to a friend’s house with a different system and expect it to run.

Enter the National Model Railroad Association (NMRA) who assembled a working group to develop a common standard in model train technology. German firm Lenz Electronics gave – yes gave – their previously proprietary protocol to the NMRA to be adopted as a standard¹. Suddenly, in order to obtain the NMRA imprimatur, all manufacturers had to conform to single technical standard. Not only did the technology succeed but it literally exploded. It now supports amazing lighting effects, an array of advanced automation capabilities and even digital sound. Best of all, the technology is fully interoperable. Some firms chose not to adopt the common standard and eventually disappeared. But most of those who embraced the NMRA DCC standard continue to thrive today.

It was at this point in our discussion that Carlos asked, ‘Where is the NMRA for healthcare?’ Great question! Today, CMS is creating incentives for hospitals to adopt enhanced healthcare information technology (HIT), introducing new concepts and standards like ‘meaningful use.’ But what is the future for widespread interoperability in healthcare and what will that journey require?”

Visit here to read the full article.

Senators introduce bipartisan effort to make medical devices safer

Oregon's Senator Jeff Merkley, with Senators Chuck Grassley (R-IA), Michael Bennet (D-CO) and Herb Kohl (D-WI), introduced the bipartisan Ensuring Safe Medical Devices for Patients Act. The bill would give the Food and Drug Administration the tools it needs to improve oversight of medical devices. Defective medical devices have been associated with thousands of deaths in recent years.

"As the Senate Special Committee on Aging heard first-hand last year, faulty medical devices, especially those implanted in the body, can have a disastrous impact on the health of those who use them," Kohl said. "Innovative technology has provided valuable, life-saving medical devices that have prolonged life and reduced suffering, but the drive toward getting new technologies to market shouldn't be done at the risk of patient safety. This legislation will help achieve that needed and delicate balance between safety and innovation."

Safety problems and recalls of certain medical devices, including metal-on-metal hips, surgical mesh, and implantable programmable infusion pumps have called into question whether the FDA and its Center for Devices and Radiologic Health (CDRH) have the tools needed to protect patients and keep harmful devices off the market. An average of 700 different medical devices has been recalled every year since 2005. Harmful or defective devices were associated with the death of almost 5,000 Americans in 2009 alone.

The legislation builds on two important, bipartisan initiatives to improve the oversight of medical devices:

• Requires FDA to issue a final Unique Device Identifier (UDI) rule by the end of 2012, requiring implantable devices to carry a unique numerical identifier so products can be tracked through the distribution chain and once they are being used with patients. The UDI program was created nearly five years ago but FDA has not implemented it.

• Adds medical devices to the Sentinel post-marketing surveillance initiative, launched in 2008. Sentinel is a national, integrated, electronic system which currently monitors prescription drug safety after FDA approval, once the drugs are being marketed to patients.

The bill has been endorsed by Consumers Union, National Women's Health Network, National Research Center for Women and Families, Health Care Supply Chain Association, the Premier Healthcare Alliance, Association of American Medical Colleges, Alliance for Advancing Nonprofit Health Care, National Association For Continence, MedicAlert Foundation, Public Citizen, and Union of Concerned Scientists. Visit the Senator Kohl’s newsroom for the article.

"Show me the money"

Dr.Carlos Nunez, Chief Medical Officer at CareFusion explores trends and issues facing the healthcare industry and in respiratory care practices at CareFusion’s Online Center for Safety. In his most recent post, Dr. Nunez discusses the need for greater cost control in healthcare.

“A curious thing is happening. As the healthcare conversation moved front and center over the last several years, a correlation developed linking cost and quality. Politicians and providers,payors and patients have embraced these complementary themes as the “one-two punch” that will win the fight to keep our healthcare system safe, solvent and sustainable. As far as punches go, it sounds almost painless: Make the system better and safer, and the savings will follow. Who would argue with that logic?

Now it seems that some prominent voices have started to pivot the conversation toward the need for greater cost control, suggesting that quality and safety efforts alone may not deliver the necessary savings. Recently, three opinion pieces appeared in the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) that call into question some basic assumptions about the economics of our health care system. Another article, published in Healthcare Finance News, added a new sense of urgency to this pivot in opinion.”

Visit here to read the blog.

A decade of “smart” infusion pumps

Dr. Tim Vanderveen, Vice President of the Center for Safety and Clinical Excellence for CareFusion, discusses trends in medication management at CareFusion’s Online Center for Safety. In his most recent post, Dr. Vanderveen, who has authored several patents in infusion technology and was one of the original creators of smart IV pumps – spotlights the 10-year anniversary of smart infusion pumps. He discusses how smart pumps have evolved and provides a glimpse into the future of medication safety.

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In February, we recognized the 10-year anniversary of “smart” infusion pumps – infusion devices with Dose Error Reduction Software (DERS).

I have often been asked why it took so long for manufactures to add “guardrails” into infusion pumps. The short answer is that until it was possible for hospitals to create in their pumps custom drug libraries and best practice drug limits, the idea of adding safety alerts was only a dream. Each time we heard about a death or injury due to an incorrectly programmed pump, we could only hope that caregivers would be more careful in the future. This was of little comfort knowing how easy it was to make a mistake and how vulnerable nurses were without a safety net.

The technological breakthrough was the flash EPROM – basically, a chip that could be programmed with a hospital-specific drug library. Because drugs may be used off-label and IV practices are often not standardized, infusion pump manufacturers began to market “dumb” pumps that hospitals could make “smart.” Thinking back to the first Alaris® smart pumps, it’s amazing that even the initially limited capabilities had such a game-changing impact on our industry. Suddenly, we were in the software business and working feverishly to expand pump safety features to meet the demands of early adopters. We helped hospitals interpret data collected from the near misses and good catches, and we worked with customers and thought leaders to reduce practice and library variation, fine tune drug limits and interpret what Dr. David Bates called the new “treasure trove” of infusion data that was stored in each pump.

Studies have shown the typical adoption cycle for new technology in hospitals averages 20-years and could be even longer in some cases. The adoption of smart IV pumps, however, is almost 70% after only 10 years. One fact that has accelerated smart pump adoption is analogous to air bags in automobiles –the safety features now come standard. And, the “good catches” that pump logs document are evidence that pumps with DERS have prevented many potentially serious and possibly fatal errors.

Over the past 10 years, we have made tremendous progress in creating a safety net for drug administration. Looking ahead, the focus will be on making infusion pumps part of a much larger medication ecosystem, where pumps inherently administer accurate doses, expanding guardrails to patient – not drug – specific capabilities.

Find out more at CareFusion’s Online Center for Safety.

From Trash to Technology: A better way to document supplies at the point of care

by Karen Conway on 2/20/2012 9:21 AM

Later today, I will climb on the plane and fly to Las Vegas to join 20 to 30 thousand of my colleagues in healthcare IT for the 2012 HIMSS Annual Conference and Exhibition. Sadly, once again this year, the role of the supply chain in meeting some of our most critical clinical and financial challenges in healthcare reform is absent from the agenda - with one notable exception. An impressive group of experts – from medicine and technology (including EMRs, clinical documentation, RFID, and system integration) will meet Wednesday afternoon at HIMSS to discuss the problems associated with inaccurate and incomplete clinical supply documentation at the point of use.

Research has shown that manual, duplicative and disjointed processes in the OR and other procedural suites result in more than $5 billion in waste each year in the US alone. To illustrate the point – while most likely the exception – a colleague recently told me about an OR where supply documentation consists of throwing packaging from supplies...

Read More »

Dim Bulbs

And the bright ideas emanating from the domed confines of Capitol Hill on how to fix healthcare and fuel reform just keep coming.

To wit, the federal government wants to impose a medical device excise tax on manufacturers to help finance the Patient Protection and Affordable Care Act of 2009. Surprisingly, this isn’t a shock because Sen. Max Baucus (D-MT) proposed it several years ago. Specifically, the ACA seeks to levy a tax “equal to 2.3 percent of the price for which a ‘taxable medical device’ is sold by a manufacturer, producer or importer.” This tax would apply to products made in 2013 and forward.

This has all the earmarkings and underpinnings of the government’s favored primary financing/fundraising mechanism, what we mere mortals among the unwashed masses would label a glorified legalized Ponzi scheme.

Like many disruptive pieces of legislation (Rep. Paul Ryan’s proposed Medicare and Medicaid reforms, anyone?) this one incites raucous debate and raises more questions than it answers.
Aside from whether it truly protects the patient or someone else in the chain and whether it really makes healthcare more affordable and for whom, the proposal’s language can be sliced and spread on wheat crackers. Yet more doctors than lawyers in Congress may not make a difference.

The proposal’s bubbly effervescence leaves the definition of manufacturer fuzzy and nebulous, but tries to persuade them and close the sale with good citizen talk about “shared responsibility” and dangling the prospect of income tax deductions.

Naturally, the providers are concerned that manufacturers merely would pass those additional costs to the hospitals that would then pass them on to the insurance companies and ultimately the patients themselves.

Save for explicitly interfering in capitalistic free enterprise by enacting rules that expressly and specifically prohibit such a shell game, taxpayers unfortunately will pay. While the government’s bailout of the banking and automotive industries may have established a precedent for the former, long-standing business and government history trumps it with latter. Good luck trying to change it.
Nevertheless, if everyone wants to benefit and prosper from a solid healthcare program that supposedly covers at least the basics for everyone then everyone should feel the growing and development pains as the fruit ripens.

Rather than belabor the foolhardiness and lambaste the silliness of this proposal any further, let’s make lemonade from this bushel of lemons with an alternatively bright idea.

Because nothing seems to please government bureaucrats more than to divert and shuffle funds from myriad projects and programs to keep all the bobbing buoys afloat, they simply should use the funds collected from healthcare providers and suppliers that run afoul of the law due to accounting improprieties, reimbursement tricks and product recalls. Within the last five years that amounts to hundreds of millions of dollars. And it’s all in the name of patient protection and safety anyway, right?

But if the government must tax (just like Tigger must bounce!), then let the government spin the tax closer to its intended message to the masses. The overarching theme interwoven throughout all healthcare reform measures is patient protection and safety to create and operate a system that delivers high quality service free of error. Although they stop short of calling it the silver bullet (count those denials among media reports since 2007) the primary weapon they promote as the saving grace is information technology.

So starting in 2013, impose a 2.3 percent income fee on every healthcare organization – provider, supplier (including manufacturer, distributor and service company) and payer that does not use IT for all healthcare financial transactions (that also would include patient records because they are tied to payments).

An 18-month lead time for adoption and implementation should be plenty even as the Food and Drug Administration mulls the eventual imposition of its Unique Device Identification (UDI) system. The feds could add a six-month grace period if it felt generosity or pity for procrastinators.
To operate as a taxpayer-funded, patient-focused accountable care organization you have to make meaningful use of rhetoric that reflects reality.

Comments?

Glancing back at 2010

Reflecting on the last year’s events, here are 11 noteworthy happenings that piqued interest:

1. Obamacare perceptions.
2. ACOh please.
3. EHR goes LED.
4. Meaningful use.
5. Equipment spending.
6. Radiating personalities.
7. Mergers and acquisitions.
8. GLN sunrise date.
9. Uncalled-for recalls.
10. iGive up. iPhones and the new iPads gained prominence.
11. Florida elects former HCA chief Rick Scott as its new governor.

Use This Link to comment

Rigorous Supply Chain Practices are not as Common in Healthcare – Why?

In a session at the GHX 2010 Supply Chain Summit, Brent Johnson, VP Supply Chain, Intermountain Healthcare said that rigorous supply chain practices are not being used in healthcare. Why?

Because of their not-for-profit presence that reduces the focus on running an efficient business; because of industry dependence upon GPOs & distributors for contract and supply chain management; lack of supply chain talent – pay & strategy opportunities are lacking; and hospital executives haven’t viewed traditional Materials Management as strategic – leaving them in the basement versus part of the C-Suite where they are in other industries.

Is this the same problem that your healthcare organizations are having?

VHA survey reveals patients stealing items from hospital rooms

After reading the VHA report on theft trends in healthcare facilities, what's the largest theft threat at your facility? And secondly, what's the most unusual item being stolen?

For the full VHA article please link here:
https://www.vha.com/News/PressReleases/Pages/SurveySouvenirs.aspx

Making the Grade

The January 2010 edition of Healthcare Purchasing News asked experts to evaluate the industry's and government's overall performance in 12 areas as they responded to the H1N1 pandemic. HPN's aim was to use the H1N1 response as a likely forecast of how both might respond to an even more serious and lethal pandemic. How would you grade the industry's and/or government's performance in any or all of the areas featured?

2010 GLN Standardization

What, if anything, is your organization doing to meet the 2010 GLN standardization deadline?

Bottled water versus tap - Response to HPN Daily Update item

In response to the Los Angeles Times article "Bottled water versus tap: Which is safer to drink? " reprinted in your Daily Update newsletter, I respectfully ask you consider the following:

Dr. Janssen and the NRDC’s laudable agenda of improving public water systems is ill served by attacking the bottled water industry. The mantra of “tap water is just as good or better” - repeated often - will require return scrutiny of what we actually get out of the 55,000 different municipal systems in our country. Much of what is known is not all that pleasant.

I could begin to detail the low standards and lax regulation of tap water by the EPA instead of the more rigorous requirements imposed on bottled water by the FDA. I could cite the recent AP reports of pharmaceuticals in tap water or refer to the numerous and readily available violation reports in state and federal records. Or you could simply go the NRDC’s own website and find that they find municipal tap water not all that tasty. http://www.nrdc.org/water/drinking/uscities/contents.asp.

Let’s not try to further our own causes by tearing down others. We don’t really want to be party to the “negative sell” against tap water. It is not only distasteful but it doesn’t make common sense because growth of bottled water has not come at the expense of tap water. All industry statistics show bottled water has taken “share of stomach” from sugary carbonated soft drinks as Americans have become more health conscious in recent years. It is a good trend that should continue.

We do have real issues we could work together with current bottled water critics to solve. We need a serious program to recycle consumer packaging. Our bottles are a piece of the overall puzzle and we are willing to work clean up our own mess. My company currently is doing its own small part using 25% recycled content in both our glass and PET plastic bottles. We need to get all of this packaging back, though, along with all of the other packaging American consumers currently discard.

Oh, and that old saw of “water is more expensive than gasoline.” That changed long before the current run up in fuel prices. We’ll deliver five gallons to your home for $7.50 in a multi-use, returnable bottle. Try asking the local gas station to do that!

Breck Speed
Mountain Valley Spring Company
Chairman/CEO
Hot Springs, AR

What to consider before adopting RFID/RTLS

For healthcare facilities considering investing in RFID/RTLS technology, how should the recent JAMA study results affect their decision to adopt and implement the technology?

(Read JAMA article)

Managing existing RFID/RTLS

For healthcare facilities that already are RFID/RTLS-equipped, how should they react and change their operations in light of the recent JAMA study results?

(Read JAMA article)

What are we missing?

Over the course of our 30th Anniversary year we have spotlighted who we think are the best and the brightest. Let us know if there is anyone who missed being recognized.

Story links to refresh your memory:
Peering off the ledger: Big deals move market share roller coaster
Recalling supply chain’s high and low points
30 years of CS pros worth knowing
Spotlighting significant news events, supply chain opportunities and threats
Three decades of MM pros worth knowing
Saluting materials management leaders

How has MRSA affected your community or hospital? We want to hear from you…

Superbugs such as MRSA are in the spotlight around the country. Tell us how MRSA is affecting your community. What is your hospital doing to fight back? What more could be done? Share your stories and post comments here.

If you missed the MRSA stories featured in the HPN Daily Update, click here to read them.