Published in the July 2008 issue of Today’s Hospitalist
CMS launches demonstration project for bundled hospital payments
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) recently announced a new demonstration project to bundle reimbursements for hospitals and physician services into single payments for more than two dozen cardiac services and nine orthopedic surgical services. Just as importantly, it will allow those hospitals to share cost savings with physicians.
Medicare hopes to make hospital care more efficient by aligning the financial interests of physicians and hospitals. While Medicare must currently pay hospitals and physicians separately, the demonstration project would allow participating hospitals to share savings with individual physicians, physician groups or other hospital staff. That concept, known as gainsharing, is currently considered a violation of antikickback statutes.
The project will launch Jan. 1, 2009 for participating hospitals in four states: Colorado, New Mexico, Oklahoma and Texas. The CMS plans to designate up to 15 hospitals as pilot sites. More information about the demonstration is online.
Intensivists’ high mortality rates in the ICU
A NEW STUDY HAS FOUND that intensivists managing critically ill patients have a higher mortality rate than non-intensivists, even when mortality is adjusted for the higher severity of illness that intensivists care for.
A retrospective analysis of more than 100,000 patients treated in 123 U.S. ICUs provided results that were “surprising and completely contrary to previously published findings,” the authors wrote.
They hypothesized that the results may have been skewed by some residual severity confounders.
They also surmised that critical care physicians may make less use of standardized practices; may perform more procedures than physicians not trained in critical care, thereby increasing patients’ risk for complications; and are probably less familiar with patients who are transferred to them, compared to other physicians who may have previously treated ICU patients.
The study, which appeared in the June 4 Annals of Internal Medicine [http://www.annals.org/cgi/content/abstract/148/11/801], called for more research to explain the findings.
Tips for better safety with insulin pens
AS MANY AS 30% of the nation’s hospitals are now using insulin pen injectors to deliver insulin to patients.
Those pens offer time and safety advantages over insulin vials, according to a recent issue of Medication Safety Alert, a newsletter from the Institute for Safe Medication Practices (ISMP). However, the number of pen devices on the market and the pens’ confusing labeling can lead to errors. Many hospitals aren’t taking the safeguards needed with insulin pens to avoid adverse events.
The ISMP noted the following problems:
Nurses make technique errors with the pens, leading to needlesticks or insulin leakage.
Nurses use pens as vials, extracting insulin with a sterile needle from the pen cartridge. That can leave air bubbles in the remaining insulin or lead to dosing errors.
Nurses also put disposable needles on pens to use the same cartridge in multiple patients, increasing the risk of contamination.
To promote better insulin-pen safety, the ISMP recommends that insulin should not be withdrawn from a cartridge unless it is malfunctioning, and that each pen should be used for only one patient.
Further, formularies should limit the number of pens being used in a facility to promote higher competency and compliance. Staff need ongoing training and support in the use of insulin pens.
The ISMP also recommends that hospitals develop written guidelines for each type of pen used in-house.
High costs due to adverse events at children’s hospitals
WHAT IS BEING BILLED as the first study to analyze complication rates of specific adverse events among pediatric patients found that complications occur in as many as 4% of patients in pediatric hospitals.
Researchers looked at administrative data on adverse events in 38 academic children’s centers during 2006, assessing costs associated with several pediatric quality indicators. They found that complications from adverse events included increased lengths of stay from between three days for accidental lacerations to 24 days for sepsis complications.
Charges incurred for those complications ranged from $35,000 to $337,000 per event, according to the report, which was published in the June issue of Pediatrics.
Authors said the results should be used to target quality improvement initiatives on specific quality indicators, particularly those related to reducing postoperative sepsis and infection.