IHBA News
Patient Information Bill Criticized
The Des Moines Register described it
The article below entitled "Hospitals, regulators in battle over rules" may help explain, at least in part, why Iowa is so far behind other states in meaningful health care transparency... and heading in the wrong direction with this pending legislation. The Iowa hospital and medical industry lobbyists are strong and at work...unfortunately not in the public's best interest. Unless something changes, they will continue to get their way. The Director of the Iowa Department Inspections and Appeals is stepping up for the public. Where are the Director of the Department of Public Health and our other state officials?
Note: Pay special attention to the readers' reactions to the story above at the end of the article.
Healthcare Reforms: Require Reporting of Errors, and Other Measures of Quality
It will promote public reporting of quality performance measures and create public awareness to educate consumers on smart health-care choices..."
Read Garth Bowen's complete article, which appeard in the March 25th Des Moines Register, by clicking no the link below »
Iowa State Legislative Briefing
Iowa Health Buyers Alliance, 2008
Numerous state initiatives are underway across the U.S. aimed at improving health care quality, patient safety, and the overall value of health care. Efforts focus on measuring and reporting to the general public quality and efficiency results of both hospital and physician performance. This type of public information is important for patients and their families, employers and other buyers. Since taxpayers pay a hefty chuck of costs through Medicare and Medicaid, hospitals and other providers should be held publicly accountable for the care they deliver. Requiring publication of quality and efficiency measures provides additional incentive for hospitals and other providers to implement practices that can reduce errors and otherwise improve quality and drive-out cost. There are many state efforts underway in the area of provider performance measurement and publication many of which support The Leapfrog Group. The Leapfrog Group is a national organization driven by health care buyers who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans.
Summary of state purchasing and public reporting efforts:
Minnesota: 1) Minnesota’s Smart Buyers Alliance which MN’s Governor has endorsed since 2004 is a coalition of public and private purchasers demanding quality and efficiency in health care. The State of Minnesota has joined private business and labor groups to drive quality improvements and efficiencies in the health care delivery system. The Governor also recently initiated Q-care which lays out hospital quality improvement and reporting benchmarks and factors in Leapfrog measures among other performance measures. 2) Minnesota adopted legislation in 2004 on public reporting of Adverse Health Events Reporting (“Never Events”). Minnesota was the first state to publicly report these results.
Maine: The State of Maine implemented an employee benefit program designed to encourage their covered people to choose Leapfrog-reported hospitals.
Massachusetts: The Massachusetts Group Insurance Commission (CIC) leads a Regional Roll-Out for Leapfrog; has a pay-for-performance program in place with its contracted health plans to encourage Leapfrog reporting; and posts Leapfrog data on its Website. The CIC lead in value-driven purchasing has informed the state’s recently enacted health care reform legislation.
Florida: The State of Florida leads the nation in public reporting of health care information to residents. Their website provides information on costs, quality and errors in hospitals. Florida adopted mandatory hospital infection reporting in 2004. In November 2005, Florida became the first state to publicly report infection and mortality rates in each hospital.
Pennsylvania: The Pennsylvania Health Care Cost Containment Council recently reported on the high costs of infections in both dollars and lives. Also, Medicaid in Pennsylvania has a hospital pay-for-performance program in place that incorporates some of Leapfrog measures.
Ohio: By the middle of 2007, consumers will be able to go to the Ohio Department of Health’s website to compare Ohio hospitals costs and quality of care. Governor Taft signed legislation to force hospitals to provide more information about the quality of medical care they provide and how much it costs (about 15 states have approved similar legislation); the State also leads Regional Roll-out for Leapfrog in Columbus.
Washington: Washington leads a Regional Roll-out for Leapfrog.
Connecticut: Connecticut adopted ”never events” legislation.
Indiana: Indiana initiated a new medical errors reporting requirement with its hospitals and cited Leapfrog.
The following states adopted mandatory reporting of hospital infections: California, Colorado, Illinois, Maryland, Missouri, New York, New Hampshire, Pennsylvania, Rhode Island, South Caroline, Tennessee, Virginia, and Vermont.
New Jersey: The state of New Jersey adopted “never events” legislation and is an active member of The Leapfrog Group.
Wisconsin: The Wisconsin Department of Employee Trust Funds is very active with the Leapfrog Roll-Out and has a pay-for-performance program in place with its contracted plans incenting them to encourage Leapfrog reporting.
Recommended Iowa Actions
1) Iowa Quality Purchasing Program Establish an Iowa quality purchasing initiative involving the State of Iowa as a purchaser and other public and private purchasers.
2) Four Cornerstones of Value-Driven Heath Care The State of Iowa through the Department of Administrative Services and the Department of Human Services (Medicaid) adopt and use the common set of RFI/RFP questions included in the HHS Four Cornerstones of Value-Driven Health Care, Version 1.0.
3) Support The Leapfrog Group and Co-sponsor Iowa Leapfrog Group Roll-Out The Leapfrog Group is a national initiative driven by organizations who buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for all Americans.
Currently there are over 1,200 U. S. hospitals publicly reporting to The Leapfrog Group’s Hospital Quality and Patient Safety Survey. Only one (1) Iowa hospital reports, Genesis Medical Center in Quad Cities. The bordering states of KS, MO, MN, IL, and WI all include formal roll-outs of The Leapfrog Group survey. Leapfrog fields a voluntary online hospital quality and safety survey and states across the country are playing their part to encourage hospitals to report to the survey and other public reporting initiatives.
The Leapfrog Group measures are becoming main-stream as they are now endorsed by the National Quality Forum (NQF) and recently included in the U. S. Department of Health and Human Services Four Cornerstones of Value-driven Health Care’s RFI. Many states have led the way or have provided leadership in Leapfrog Regional Roll-outs. It’s time for Iowa to join-in on this important effort.
4) Enact Adverse Health Events Reporting (“Never Events”) Legislation Minnesota adopted legislation in 2004 under which its Department of Health is required to track and report on the occurrence of 28 serious medical errors that should never happen. These “never events” include leaving medical instruments in patients, surgery on the wrong body part, and a range of other events. It is being saluted as a major step forward to improve the quality of care for all Minnesotans.
While Minnesota is the first state to take action and actually report publicly on these standards developed by the National Quality Forum (NQF), they are being joined by others including New Jersey and Connecticut. Many other states are considering such action. Iowa should do so as well.
5) Enact Health Infection Reporting Legislation Hospital infections are the fourth leading cause of death in the United States according to the National Center for Disease and Prevention (CDC). Based on information from the CDC, the Consumers Union reports that every year two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endures prolonged hospital stays and sometimes suffers lasting health problems. Recently, treatment of healthcare-associated infections has become more complex due to an alarming rise in antibiotic resistance.
The Iowa Healthcare Collaborative is working on a proposal for action: Healthcare Associated Infections (HAI). Their strategy is to employ a provider led voluntary exercise in self-reporting and clinical process improvement to accelerate the spread of best practice in Iowa.
Iowa legislation could recognize and couple these efforts with mandatory public reporting.
The Importance of Quality, Patient Safety and Transparency
Information about Iowa health care providers’ quality and patient safety performance, price and other information is essential. Transparency of this information has proven to be an important catalyst for improvement in health care. It is also important for consumers, patients and their families. Listed below are some examples of quality, patient safety and waste in health care issues:
- Rand: Only 50% chance of getting the right care when visiting the doctor’s office.
- Institute of Medicine (IOM): 98,000 preventable deaths in hospitals each year. In 2004 Health Grades reported this number to be 195,000 people, almost twice the number from the 1999 IOM report.
- Center for Health Transformation: You are 2,000 times more likely to die in the hospital from a mistake than in an airplane.
- The Leapfrog Group: The 1st three Leaps can save 58,300 preventable deaths and multiple times this # of disabilities; 522,000 medication errors; and at least $ 9.6 billion per year.
- The Juran Institute/Midwest Business Group on Health: 30%+ of health cost due to poor quality/ineffective care.
- Consumers Union: Every year, two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endures prolonged hospital stays and sometimes suffers lasting health problems.
- John Toussaint, MD, CEO of ThedaCare, Appleton, Wisconsin: “About 70% of what we do is non-value-added (waste).” (Institute for Health Care Improvement (2-16-05)). Note: Lean experts estimate 60% waste in health care.
- The Institute of Medicine: “Between the care we have and the care we could have lays not just a gap, but a chasm. The current care systems cannot do the job. Trying harder will not work. Changing the systems of care will.” (Institute of Medicine’s: Crossing the Quality Chasm)
- Pennsylvania Governor Rendell launched a new program in January, 2008 through the Department of Public Welfare to identify and stop payments for care related to preventable hospital errors. The state also will prohibit hospitals from charging patients for such errors.
- Pennsylvania Health Care Cost Containment Council: During 2005 the sates hospitals reported 19,154 cases in which patients contracted hospital-acquired infections. The hospitalizations resulting from these infections amounted to 394,129 days and $3.5 billion in hospital charges. The average hospital charge for patients with hospital-acquired infections was $185,268 while the average charge for patients without hospital-acquired infections was $31,389. The average length of stay for patients with hospital-acquired infections was also longer at 20.6 days, compared with 4.5 days for those who didn’t contract hospital infections. Most telling, though, was the figures on patient deaths. The report said that while 2.3% of patients who didn’t acquire infections died, the mortality rate for those who did contract infections was 12.9%--- more than 5 ½ times higher.
For more information:
Iowa Health Buyers Alliance
100 Court Avenue, Suite 215
Des Moines, Iowa 50309
515-282-7727
contact@ihbaonline.org
Iowa State Legislative Briefing 2007
Read it here.
Treating Heart Disease, Heart Attack, and Stroke – The Antiplatelets
For most people who need a blood-thinning drug to help prevent a first or repeat heart attack or stroke, aspirin is the drug of choice, according to the latest report from the Consumer Reports Best Buy Drugs project.
Aspirin is one of four drugs in a class of medicines called antiplatelets. The medicines decrease blood clotting, which evidence now shows is intimately tied to heart attack and stroke risk. As a result, the use of aspirin and other antiplatelets has skyrocketed in recent years.
The Best Buy Drugs Report evaluates the effectiveness, safety, and cost of the four drugs in varying clinical circumstances — aspirin, Aggrenox (a combination of aspirin and the drug dipyridamole), Plavix (clopidogrel) and Ticlid (ticlopidine).
The report discusses in consumer-friendly language the fast-moving changes in cardiology that impact the use of antiplatelets. Several major studies have underscored the effectiveness of these medicines and when angioplasty and stents are needed. Central to these developments is distinguishing between people who have so-called stable versus unstable angina — chest pain due to artery narrowing and/or blockage.
Consumer Reports Best Buy Drugs now has free reports on 17 categories of medications, including:
- Statins for high cholesterol
- ACEI drugs, beta-blockers, and calcium channel blockers for high blood pressure
- Menopause drugs
- Antihistamines for allergies, hay fever, and hives
- NSAIDs for arthritis pain
You'll also find new shoppers guides with advice on how to save money on your medications.
IMPROVING QUALITY AND VALUE IN HEALTH CARE
Community Leaders Seeking Collaboration
Last month the US HHS Secretary Mike Leavitt recognized Iowa Health Buyer's Alliance and Health Policy Corporation of Iowa as Community Leaders. We are sending you this special note today because your suggestions matter to us.
Iowa Businesses Commit to National Initiative for Improving Quality and Value in Health Care
Two Groups Recognized as Community Leaders
In a meeting today in Des Moines with HHS Secretary Mike Leavitt, executives from area businesses signed statements of support for a national initiative aimed at improving health care quality, information and cost-effectiveness for employees and their families. The Secretary recognized Iowa Health Buyer’s Alliance and Health Policy Corporation of Iowa as Community Leaders at the event.
Altogether, more than 600,000 people will benefit by implementation of this initiative in Iowa. Employers signing on include the American Republic Insurance Company; AmerUs Group; David P. Lind and Associates; Des Moines University; Health Policy Corporation; Iowa Association of Business and Industry; Iowa Bankers Insurance & Services; Iowa Foundation for Medical Care; Iowa Health Buyers Alliance; Pella Corporation; Principal Financial Group; Rockwell Collins; City of Ames; City of Cedar Rapids; City of Des Moines; Iowa State Education Association; and State of Iowa Department of Management.
The executives pledged to provide quality and price information about doctors, hospitals and other medical providers for all enrollees in their health care insurance programs. This information will help employees choose health care providers based on the quality of care they deliver and the prices
they charge.
In addition, the employers will support health information technology by encouraging the use of recognized interoperability standards in the health IT products used by their health plans. They also pledged to develop incentives for achieving better value in health care, including incentives for high quality care and for more active involvement by employees in choosing their health care services.
President Bush committed federal health programs to the four cornerstones through an Executive Order last August. In November, Secretary Leavitt invited all employers, in both the private and public sectors, to take these same four steps. By committing to these goals, Secretary Leavitt said, “Our individual actions will be aligned toward reaching the common national goal of better health at lower costs for all Americans. Today, purchasers in Iowa are joining with the federal government in adopting the four cornerstones of value-driven health care.”
“I am proud that leading Iowa employers are choosing to support these four cornerstones to achieve better health care and better value for employees and their families,” Secretary Leavitt said. “Until now, it has not been possible for patients to learn in advance about the quality of care they can expect to receive from a provider, or the cost of the services they will incur. By making this information available, employers can help their employees get better care and better value in health care.
“With the commitment that Iowa employers like these are now making, I expect many changes in health care,” Secretary Leavitt said. “Patients will come to expect quality and performance information about health care providers. They will expect to have price or cost information in advance to make good value decisions about their care. They will use this information to improve health care value for themselves and their families. And the choices they make will help improve value and health care quality across the health care sector.”
Secretary Leavitt recognized the Iowa Health Buyer’s Alliance and Health Policy Corporation of Iowa as Community Leaders, a designation bestowed to organizations who agree to support the cornerstones at the local and regional level. Recognition of the two groups represents a step in building a national network of regional organizations that bring together local stakeholders to improve health care while holding costs down.
More information on Value-Driven Health Care is available at www.hhs.gov/transparency. For a full list of companies who have signed statements of support, including those signing in Iowa today, visit: http://www.hhs.gov/transparency/employers/statements.html.
Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
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Secretary
Mike Leavitt
At a special Friday, March 9 Renaissance Savery Hotel Cost: $30
Secretary
Leavitt will discuss the work of the Department of Health & Human
Services to encourage support and widespread adoption of four strategies to
improve health care quality and affordability. Cornerstones of Value-Driven Healthcare:
Leaders
of
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Main article: A Dose of Transparency
What Health Care Needs to Be About
One expert’s views
Elizabeth TeisbergElizabeth Teisberg visited Governing’s office a few weeks ago to talk about what’s wrong with the U.S. health care system and what role Web sites that provide cost and quality information play in the drive to reform a dysfunctional system. Teisberg is co-author with Michael E. Porter of “Redefining Health Care: Creating Value-Based Competition on Results,” (published by Harvard Business School Press) and an associate professor at the University of Virginia’s Darden Graduate School of Business.
Here are some of her observations:
· The health care system needs to be about health and care, but so much of it is about reimbursement and access and payment. Pay for performance, evidence-based medicine and managed care are powerful ideas for reform that got morphed into different ideas. They end up specifying processes, and we then pay for compliance. But our understanding of the right processes changes. And, when we specify a process doctors have to perform, we get into administration and management.
· It seems like every time we focus on reducing costs, we increase them. The goal of health care reform is not cost-cutting. It’s to improve value — the quality of outcomes for money spent. So we need to focus more on results. If you want to make sure you’re doing something right, measure results and report them.
· Doctors need measures. We assume all doctors provide excellent care with small variations. The truth is, there are large variations. Our ties to results and science and state-of-art practice are not as strong as we believe. It’s important to see how we’re doing and why and to use multiple measures of results.
· The U.S. health care system is more competitive than any system but it’s still dysfunctional. What people compete over is how to shift costs — make sure costs don’t land on them. That doesn’t create value. The right kind of competition should create value and multiple winners. Why don’t we have the right kind of competition? It’s at the wrong level: It’s among health plans and hospital systems. Hospitals compete over doing the most procedures instead of driving to improve results.
· Consumer-directed health care can’t succeed. Consumers have very little choice. They’re captives of physicians. Doctors are competing. They don’t want to show up at the bottom 25 percent. The importance of reporting results is not just to enable patients to get information but for physicians to improve.
· Web sites about hospital costs and quality of care are providing information at the wrong level. A hospital’s infection rate is important, but you need it at the medical-condition level — results for specific conditions. It doesn’t matter if a hospital is good at X or Y if the condition you have is not either of those.
· Patients can’t make sense of piecemeal prices on some of the Web sites. It’s like giving me prices for the components of a car and asking me which pieces I want to buy. The point of reform is not to put the consumer in charge but to drive quality and efficiency simultaneously. And in most industries that’s what happens. But it requires competition at the right levels.
· We have to enable outcome measurement. We should require it. The gold standard is what the federal government has for transplants: universal collection of outcomes measures, publicly reported and peer reviewed. In other areas of care where we have outcome data, we see dramatic improvement in results. New York State requires heart-bypass data. And what they’ve found is a 50 percent reduction in the death rate for patients who go to high-rated places. But patients don’t pay attention to the data.
—Penelope Lemov
Americans With Insomnia May Be Relying Too Heavily
On Sleeping Pills
Americans with insomnia may be relying too heavily on sleeping pills instead of trying safer non-drug remedies, according to a new free report from Consumer Reports Best Buy Drugs. If you take sleeping pills, you should discuss their use with your doctor, and take them for the shortest period possible because of the risk of side effects and misuse.
The latest Best Buy Drugs report on insomnia examines four heavily promoted drugs -- Ambien, Lunesta, Sonata and Rozerem -- for their effectiveness, side effects and price. Although the drugs are effective, the report finds these medicines are not necessarily better than older, less expensive drugs for many people who need a sleep aid for a few nights.
All sleeping medicines have side effects, including daytime sleepiness, dizziness and rebound insomnia. They also can cause dependency and even worsen insomnia if misused or taken
too often.
The report stresses that people with mild or occasional insomnia may be relying too heavily on pills. It suggests first trying behavioral therapy to improve sleep habits, and suggests methods
to correct them.
The insomnia report is one of 14 in a series comparing the effectiveness and cost of prescription drugs to treat a range of illnesses and conditions. All the reports are available to consumers free at Consumer Reports Best Buy Drugs.
Four steps to help you prevent Cancer!
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1. Maintain a healthy weight throughout your life.
2. Eat five or more servings of a variety of vegetables and fruits each day.
3. Be physically active for 30 minutes or more at least five days a week.
4. Do not use tobacco products.
These simple steps can add up to big changes in your health and may help reduce your risk of getting many kinds of cancer. For more cancer prevention tips, visit the American Cancer Society at www.cancer.org or call 1.800.ACS.2345. (Note: The cancer survival rate is climbing. The five-year survival rate is 3 in 5 or 64 %.)
STROKE: Remember The First Three Steps
Stroke Identification:
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During a BBQ, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die. They end up in a helpless, hopeless condition instead.
It only takes a minute to read this...
A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.
Recognizing a Stroke
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Thank God for the sense to remember the "3" steps, STR . Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions:
S *Ask the individual to SMILE.
T *Ask the person to TALK, to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today)
R *Ask him or her to RAISE BOTH ARMS.
NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue... if the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.
