Quality Indicators: CMS Reporting

From the Iowa Hospital Association Friday mailing:

PPS hospitals must begin submitting data on seven indicators (reduced from 10) to an as yet undisclosed contractor beginning with outpatient services provided on or after April 1, 2008 in order to receive the full payment update for 2009. Like the inpatient PPS quality reporting program, non-compliant hospitals will receive an update factor reduced by 2 percentage points for the duration of 2009.

The seven measures CMS is requiring for the initial implementation of the the Hospital Outpatient Quality Data Reporting Program have been endorsed by the National Quality Forum and include (emphasis added):

• Emergency department (ED) transfer acute myocardial infarction (AMI) 1: Aspirin at
arrival
• ED-AMI-2: Median time to fibrinolysis
• ED-AMI-3: Fibrinolytic therapy received within 30 minutes of arrival
• ED-AMI-4: Median time to electrocardiogram
• ED-AMI-5: Median time to transfer for primary PCI
• Physician Quality Reporting Initiative (PQRI) #20 (Perioperative Care): Timing of antibiotic prophylaxis
• PQRI #21 Perioperative Care: Selection of prophylactic antibiotic

No liability for doctor who revived newborn

From the Seattle Times

A doctor can't be held liable for resuscitating a baby who was born without a heartbeat and survived with severe disabilities, the state Supreme Court says.

The baby's parents filed a malpractice lawsuit after the baby's 2004 birth. They claimed doctors in Vancouver, Wash., were negligent when they continued to resuscitate the baby for almost half an hour, after he was born without a heartbeat.

The parents also said the medical team should have gotten their consent before continuing to revive the baby.

But the Supreme Court justices say the doctor can't be held liable for failing to stop resuscitation efforts on a baby.

New High or Hoax?

From ABC News:

Police in Naples, Fla., are on the lookout for users of "jenkem," a homemade drug created by allowing human urine and feces to ferment in a bottle with a balloon covering the opening. Users inhale the released methane gas from the balloon to get a "euphoric high similar to ingesting cocaine, but with strong hallucinations of times past," according to a Collier County Sheriff's Office bulletin.

The downside: "Subjects who used the jenkem disliked the taste of sewage in their mouth and the fact that the taste continued for several days."

Immunization Frequency

From the Wall Street Journal Health Blog:

We may be getting far more immunizations than necessary, according to findings from a study in the current issue of the New England Journal of Medicine.

Antibodies from some vaccines stay around in the blood stream for much longer than previously thought, which means that the current schedules for some vaccinations may be overkill, the WSJ reports.

Tetanus shots, for instance, could be given every 30 years instead of every 10. And we seem to be protected from measles, mumps, and rubella for life, the researchers at Oregon Health and Science University find.

ED's: "Wrong place for mental-health care"

From the Boston Globe:

Hospital emergency departments are among the least appropriate and most expensive places in Massachusetts for patients in psychiatric crisis. Yet these departments are where police, families, group homes, nursing homes, and others routinely take people who are agitated, panicked, or threatening to hurt themselves. Emergency departments are also where people go at the end of the month when their medications run out, when their primary physicians can't see them for two weeks, when they are frightened or desperate and have nowhere to turn after 5 p.m. and their therapist's answering machine tells them to go to the emergency room.

Medicaid and Self Pay

From Reuters:

The government's Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation's 47 million uninsured, according to a study published on Thursday.

Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid.

"What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does," said Renee Hsia, an emergency room doctor and researcher at UCSF who led the study.

"This runs counter to the widespread impression that the uninsured are universally poor payers," said Hsia, who noted that the ranks of uninsured include healthy young people who are employed full-time.

MRSA Isolation

From the Houston Chronicle

SYRACUSE, N.Y. — A Syracuse hospital is taking an unusual approach to stopping the spread of antibiotic resistant staph infections by putting all patients with the superbug on the same floor.

Since 2000, Crouse Hospital has operated a unit on the seventh floor of its Memorial unit that cares exclusively for patients with MRSA, or Methicillin-resistant Staphylococcus aureus.

Hospital officials say the dedicated 17-bed unit — the only one of its kind in the United States — has slowed the spread of MRSA in the hospital, improved patient care and saved the hospital about $1 million.

Just Say No?

From MedPage Today. Tales from the ER.

I thought I had heard it all, but I got a new threat recently. The context was one in which I felt a little bad about having to say no. The patient was a grandmotherly sort of lady in her middle years. She presented a sad and pathetic figure as she told me her tale of ongoing diffuse body pain which was poorly controlled even on high doses of methadone. Alas, she was out of her meds and wanted a refill (actually, her initial request was to be admitted to the hospital). She was unable to explain how she had come to be out of her pain medications.

She escalated; I explained my thought process. She yelled, she wept, and she begged. I held firm, and she was discharged. On her way out she stopped by the charting station and said, with a vicious spite in her voice, "I hate you. You are a terrible, terrible person, and I hope you suffer, and I hope your children suffer. In fact, I am going to make sure of it. I am going to go home and make a voodoo doll of you and all of your children and I am going to stick pins in all of them!"

Amazing Story

From CNN.com


On July 2, Powers, a squad leader in the 118th Military Police Company out of Fort Bragg, and his unit were called to investigate a report of a late afternoon explosion in a Baghdad neighborhood. For the unit, it wasn't anything they hadn't seen before. They were on their second tour of duty in Iraq to train Iraqi police officers.

The explosion was minor and Powers walked away from the area to deal with the crowd that had gathered.

It was then that Powers felt something hit his head.

"I wondered briefly if I had been shot," he says.

In reality, Powers had been stabbed in the head. And the nine-inch knife was still stuck into the right side of his cranium.

Energy Drinks and EtOH Don't Mix

From the WSJ Health Blog

Researchers there found that college students who down cocktails of booze and energy drinks, such as Red Bull, run a significantly higher risk of injury compared with students who stick to uncaffeinated alcoholic beverages. The students sucking down Speed Balls, Bullgaritas and Bull Breezes were much more likely to be hurt or injured, to ride with an intoxicated driver or to take advantage of someone else sexually.

The results follow several studies that found mixing alcohol, a depressant, and caffeine, a stimulant, can make people feel less drunk than they really are.

Some mental health patients to be diverted to ERs

From the Austin Statesman

More people with mental illnesses could soon be sent to local emergency rooms instead of Austin State Hospital, and hospital officials say that could clog waiting rooms and cause longer waits for medical care throughout the Austin area.

On Nov. 8, the Austin Travis County Mental Health Mental Retardation Center will start reducing the number of people it sends to the state hospital by 43 percent — an estimated 600 to 900 people each year. Those people will be taken to emergency rooms, including ones at Brackenridge Hospital, Dell Children's Medical Center of Central Texas, Heart Hospital of Austin and St. David's Medical Center, said Jim Van Norman, MHMR's medical director.

Hospitals face fight for tax-exempt status

From the ContraCosta Times

A U.S. senator has warned that if some nonprofit hospitals continue to oppose greater transparency in the community benefits they provide, he may seek stricter requirements on such institutions.
"While everyone talks about the need for sunshine, there are a few tax-exempt hospitals in the shadows that are bent on pulling the blinds and closing the drapes," said Sen. Chuck Grassley, R-Iowa.

The comments from the ranking member of the Senate finance committee came during a Tuesday roundtable discussion in Washington on whether nonprofit hospitals provide enough charity care to justify their hefty tax breaks.

Grassley noted that the Internal Revenue Service has proposed changes in its Schedule H and Form 990 that would require nonprofit hospitals to provide greater details on their charity care and other community benefits.

He called the proposed change in reporting requirements "a dramatic improvement over business as usual" and criticized hospitals that are opposing it.

"It is disgraceful that they are misleading Congress" in trying to water down and delay the Schedule H changes, he said.

"If these hospitals continue to press for keeping the public in the dark about how they justify $50 billion in tax breaks a year, that will greatly color my views about the need for legislation."