Without further adieu — and just in time for the Supreme Court to rule on its constitutionality — we have published our Affordable Care Act (ACA) Timeline. Many available timelines regarding key provisions of the ACA are either hard to understand, lack important implementation dates, or lack references to source materials.
These shortcomings led to the development of our own ACA Timeline, which is an evolving piece of work. We are continuing to update it with additional key provisions and citations.
On April 26, 2012 the Pennsylvania Health Care Cost Containment Council (PHC4) released a report detailing hospital readmission statistics from 2010 data. The report is particularly noteworthy because this month the first group of Accountable Care Organizations (ACOs) begin participating in the Medicare shared savings program. One of the quality measures on which health care providers participating in the ACO are evaluated is hospital readmissions. Later this year, all Medicare providers will also be subject to the Hospital Readmission Reduction Program.
We previously wrote about an amendment to the Pennsylvania Health Care Facilities Act that imposed specific photo identification requirements. Although the Act was specific, it left much of the implementation state Department of Health (DOH).
On December 10, 2011, the DOH published interim regulations that implement the photo identification requirements. The regulations have limited application because the photo id requirements are staggered in implementation. The interim regulations, therefore, only apply to 1) individuals who provide direct patient or consumer care outside of a health care facility or employment agency, or 2) employees of a private practice physician.
Until June 1, 2015, the photo id requirements do not apply to individuals who provide direct care at a health care facility. However, the interim photo identification regulations for those who provide care outside of a health care facility were effective as of December 10, 2011, when the regulations were published in the Pennsylvania Bulletin.
Physicians and medical malpractice attorneys alike probably speculate that practitioners of the various surgical specialties carry the highest risk of being named in a malpractice lawsuit. After all, adverse events in those fields have the potential to be catastrophic and tend to be associated with large payouts for plaintiffs. In actuality, they may be wrong, according to recent trends.
Providing high quality care is not strongly associated with a reduction in litigation exposure according to a recent study published in the New England Journal of Medicine. The results of this study, while frustrating to some, reaffirm our belief that litigation has more to do with the process of care rather than the quality of care; I have written about this point in the past.
The New England Journal authors sought to assess “whether high-quality health care institutions are less likely to be sued for negligence than their low-performing counterparts.” Although this premise may seem logical, its validity has been questioned by many studies.
The Centers for Medicare and Medicaid Services (CMS) published a proposed Rule prohibiting payment for certain health care acquired conditions (HAC) under the Medicaid program. Effective October 1, 2008, under the Medicare program, CMS stopped reimbursing health care providers for HACs that were not present upon admission of the patient to the hospital. CMS did not address payment under the Medicaid program at the time but instead sent a letter to state Medicaid program directors regarding how states can adopt the same practices. CMS recently issued a proposed Rule, however, that will prevent states from being reimbursed through the Medicaid program for treatment of HACs. The problem is, the HACs for which CMS will permit reimbursement differ between the existing Medicare rules and the proposed Medicaid rule, leading groups such as the American Hospital Association to urge consistency.
Studies have repeatedly shown that a prominent vulnerability to patient safety exists in the hand-off between hospital care teams, such as during shift changes. During this critical period, important information about a patient’s condition or plan of care may not be communicated or accurately understood by the oncoming team. For this reason, The Joint Commission has proposed solutions to address the threats of adverse events related to care transitions; the Joint Commission’s proposals were developed through its Center for Transforming Healthcare, which worked with 10 hospitals to identify the root causes of hand-off communication failures during the transition of care and develop targeted solutions for each of those causes.
The Archives of Internal Medicine published a recent study of computerized physician order entry (CPOE) at the University of Pennsylvania that was halted due to unintended treatment delays associated with the CPOE system. The study reflects the desire to improve patient outcomes and reduce potential error through the use of electronic resources, but demonstrates that those resources must be carefully studied prior to implementation and monitored. The study and the ultimate result is particularly notable in the context of the transition to electronic health records and the necessary use of CPOE to constitute “meaningful use” to qualify for Medicare incentive payments.
We previously wrote about the announcement of grants by the Department of Health and Human Services for patient safety and medical liability projects. Communication among health care providers is fundamental to avoiding certain errors. Equally important is communication between healthcare providers after an error occurs to provide accountability to the patient, which is often the motivation behind malpractice lawsuits. One of the grant recipients, Dr. Thomas Gallagher of the University of Washington, plans to focus these two aspects of communication in his grant-related research.
Chief among Dr. Gallagher’s goals are to train healthcare providers in effective communication to both prevent and respond to errors at 10 institutions throughout Washington. He intends to track “communication sensitive events,” which could include medication errors, wrong-site surgery, wrong surgery, advanced pressure ulcers, or other never-events, which are often attributed to a breakdown in communication between healthcare providers. Read more
On June 11, 2010, The Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) announced the award of grants funded pursuant to a Presidential initiative to study methods of improving patient safety and instituting medical liability reforms. This brings to fruition President Obama’s promise during his September 9, 2009 address to the joint session of Congress that HHS would study medical liability reform models. HHS summarized the President’s direction as follows:
As part of his vision for a health care system that puts patient safety first and allows doctors to focus on practicing medicine, the President directed the Secretary of HHS to help States and health care systems test models that: (1) put patient safety first and work to reduce preventable injuries; (2) foster better communication between doctors and their patients; (3) ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and (4) reduce liability premiums.
The overall funding for this program was $25 million, which was distributed among 7 Demonstration Grants and 13 Planning Grants. Read more