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| Study: Performance Measures Not Indicative of Quality Patient Care
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Thanks to the proposed update to the Outpatient Prospective Payment System, hospital outpatient departments will depend on the quality data reporting of their inpatient departments for full Medicare payment updates in 2007. However, that data may not be as reliable as the federal government believes, according to a study in the Dec. 13 issue of the Journal of the American Medical Society.
"The results of this study raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals," writes Susan D. Horn, PhD, of the Institute for Clinical Outcomes Research in Salt Lake City in an accompanying commentary.
Researchers compared 3,657 hospitals with high and low Medicare performance measures by analyzing data from CMS's Hospital Compare database. In comparing 10 process performance measures with risk-adjusted death rates, they found little difference in the rate of death for heart attack, heart failure and pneumonia at the hospitals.
Across all heart attack performance measures, the absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile versus those performing in the 75th percentile was 0.005 for inpatient death, 0.006 for 30-day death and 0.012 for death at one year. For the heart failure performance measures, the absolute death reduction was smaller, ranging from 0.001 for inpatient death to 0.002 for one-year death. For the pneumonia performance measures, the absolute reduction in death ranged from 0.001 for 30-day death to 0.005 for inpatient death.
"These findings should not undermine current efforts to improve healthcare quality through performance measurement and reporting," the study's authors write. "However, attention should be focused on finding measures of healthcare quality that are more tightly linked to patient outcomes. Only then will performance measurement live up to expectations for improving health care quality."
CMS is implementing outpatient-pay-for-inpatient-performance because it believes inpatient quality of care parallels that of outpatient departments; the agency says it will continue to follow this standard until it can develop and adopt appropriate quality measures specific to HOPDs.
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| Ohio Weighs Specialty Hospital Ban
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It's open season once again on specialty hospitals, this time at the state level. While an 18-month federal moratorium on the physician-owned facilities just ended in August, an Ohio state senator introduced legislation last week that would halt the construction of specialty hospitals in the state for one year.
State Sen. Steve Austria, R-Beavercreek, introduced the bill after the heads of 14 Ohio hospitals petitioned legislators to put restrictions on niche hospitals. Their lobbying follows plans by a Springfield-based surgeons' group to build their own hospital, plans that coincide with Community Mercy Hospital Partners' plans to create a $300 million downtown medical campus that would merge two area hospitals.
"Senator Austria is concerned that a specialty hospital moving into the area would drain (non-profit) Community Mercy's revenue," says his spokesperson. The Ohio General Assembly recesses on Dec. 21. If Sen. Austria's Senate Bill 403 doesn't get passed by then, it will have to be reintroduced in the general assembly's next session, says the spokesperson. If the bill is passed and signed before the end of the year, the spokesperson says, it could take effect as early as February.
Sen. Austria is the third local lawmaker to introduce a bill designed to stall the creation of specialty hospitals. State Reps. Ross McGregor, R-Springfield, and Chris Widener, R-Springfield, co-sponsored a bill that would require specialty hospitals to have 24-hour emergency departments and maintain contracts with Medicare and Medicaid.
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| Quick Colonoscopies Can Miss Polyps
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A study in the Dec. 14 issue of the New England Journal of Medicine suggests that the effectiveness of a colonoscopy may depend on how much time is allotted to the procedure: the quicker you are, the more likely you are to miss polyps.
For the study, 12 experienced gastroenterologists performed almost 8,000 colonoscopies during a 15-month period, recording information about the patient, their findings and how much time was spent on the procedure. They found a large difference in how often adenomas were detected that correlated with the time spent withdrawing the colonoscope from the cecum to the anus. The physicians with a mean withdraw time of six minutes or more had significantly higher rates of detection for any form of neoplasia (28.3 percent versus 11.8 percent) and advanced neoplasia (6.4 percent versus 2.6 percent) than those with lower mean withdraw times.
The study's principal author, Robert Barclay, MD, of Rockford Gastroenterology Associates in Rockford, Ill., notes that the effect of withdraw time for detecting lesions and preventing colorectal cancer in the context of widespread studies remains unknown. "Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies," he writes.
In an accompanying editorial, David Lieberman, MD, professor of medicine at Oregon Health and Science University in Portland, explains that longer procedure times don't necessarily mean better healthcare, but the results of Dr. Barclay's research are intuitive and research into the quality of healthcare should be a part of the culture for everyday clinical practice. "There is a lesson here for every practitioner in every specialty," he writes.
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| News and Notes |
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MEDICARE WON'T CUT PHYSICIAN PAYMENTS, at least not in the immediate future. As one of its last actions before adjourning for the year, Congress passed a tax cut bill that freezes physician payments for 2007, forestalling the 5.1 percent cut that had originally been proposed. The legislation also provides for the possible issuance of 1.5 percent bonus payments in the second half of the year as part of a pay-for-performance system. The American Society of Anesthesiologists, however, claims such a system is "complex and controversial", while the American Society of Cataract and Refractive Surgery argues that the terms of the quality reporting are "unclear." The ophthalmologists' group also notes that cuts relating to work relative value units were not addressed by the legislation and therefore will still take effect.
COMPOUNDED TOPICAL ANESTHETIC CREAMS pose dangers to patients and should no longer be marketed for general distribution, according to an FDA warning letter sent to five compounding pharmacies nationwide. Because the creams are not made according to the "unique medical needs of individual patients," they "can cause grave reactions including seizures, irregular heartbeats and death," according to the agency. The FDA notes that two deaths have been connected to compound topical anesthetic creams made by Triangle Compounding Pharmacy and University Pharmacy, both of which received letters. Compounded topical anesthetic creams are often used to lessen pain in procedures such as laser hair removal, tattoos and skin treatments. Only properly labeled, FDA-approved topical anesthetic products should be used for this purpose; when pharmacies create their own standardized versions of these products — which often include combinations of lidocaine, tetracaine, benzocaine and prilocaine at higher strengths than found in FDA-approved products — the potential for harm is increased.
IS YOUR FACILITY PREPARED TO PREVENT AND RESPOND TO SURGICAL FIRES? AORN partnered with medical device manufacturer Megadyne to develop a Fire Safety Tool Kit to raise healthcare employees' awareness of the hazard of surgical fires and to educate them with prevention and response strategies while assisting administrators in developing safety policies and protocols to protect patients, staff and the facility. The kit includes a DVD on surgical fires, a sample emergency plan, interactive software, posters and literature. AORN members can receive four free contact hours for successfully completing the kit's content. |
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| Corrections |
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MEDICARE WON'T CUT PHYSICIAN PAYMENTS, at least not in the immediate future. As one of its last actions before adjourning for the year, Congress passed a tax cut bill that freezes physician payments for 2007, forestalling the 5.1 percent cut that had originally been proposed. The legislation also provides for the possible issuance of 1.5 percent bonus payments in the second half of the year as part of a pay-for-performance system. The American Society of Anesthesiologists, however, claims such a system is "complex and controversial", while the American Society of Cataract and Refractive Surgery argues that the terms of the quality reporting are "unclear." The ophthalmologists' group also notes that cuts relating to work relative value units were not addressed by the legislation and therefore will still take effect.
COMPOUNDED TOPICAL ANESTHETIC CREAMS pose dangers to patients and should no longer be marketed for general distribution, according to an FDA warning letter sent to five compounding pharmacies nationwide. Because the creams are not made according to the "unique medical needs of individual patients," they "can cause grave reactions including seizures, irregular heartbeats and death," according to the agency. The FDA notes that two deaths have been connected to compound topical anesthetic creams made by Triangle Compounding Pharmacy and University Pharmacy, both of which received letters. Compounded topical anesthetic creams are often used to lessen pain in procedures such as laser hair removal, tattoos and skin treatments. Only properly labeled, FDA-approved topical anesthetic products should be used for this purpose; when pharmacies create their own standardized versions of these products — which often include combinations of lidocaine, tetracaine, benzocaine and prilocaine at higher strengths than found in FDA-approved products — the potential for harm is increased.
IS YOUR FACILITY PREPARED TO PREVENT AND RESPOND TO SURGICAL FIRES? AORN partnered with medical device manufacturer Megadyne to develop a Fire Safety Tool Kit to raise healthcare employees' awareness of the hazard of surgical fires and to educate them with prevention and response strategies while assisting administrators in developing safety policies and protocols to protect patients, staff and the facility. The kit includes a DVD on surgical fires, a sample emergency plan, interactive software, posters and literature. AORN members can receive four free contact hours for successfully completing the kit's content. |
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