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2018-01-26 / News

Pennsylvania hospitals show year-over-year improvement

Regional Business Analyst

In December 2017 Medicare announced that it will penalize 751 hospitals across the country for falling below the Hospital-Acquired Condition Reduction Program’s threshold for preventing hospital-acquired conditions (HACs), according to the Centers for Medicare and Medicaid (CMS). Hospitals in the bottom 25 percent of the 3,306 hospitals evaluated will receive a 1-percent reduction in Medicare reimbursements during the fiscal year.

The HAC Reduction Program began in October 2014 as a condition of the Affordable Care Act and was intended to reduce HACs and hospital readmissions. When hospitals started to receive this penalty, the numbers stayed relatively flat, but in the past year, Pennsylvania has seen an 18 percent decrease in the number of hospitals penalized.

According to The Hospital & Healthsystem Association of Pennsylvania in Harrisburg (HAP), its Hospital Improvement Innovation Network (HIIN), which is a three-year funded initiative by CMS with 100 participating hospitals, has helped lower the number of HACs and readmissions at some hospitals in the state.

“We’re proud of our Hospital Improvement Innovation Network,” said Robert G. Shipp III, vice president of population health strategies for HAP. Prior to coming to HAP, Shipp worked as a nurse manager for 12 years.

“HAP was one of the original hospital engagement network organizations that worked with hospitals to focus specifically on reducing harm, improving patient safety and reducing readmissions.”

Currently, there are only 16 organizations across the country that receive HIIN funding from CMS to focus specifically on hospital harm events and readmissions.

The point system metrics employed by CMS is not a straight-forward counting of the number of HACs at a given hospital, but rather HACs are categorized into two domains in which certain conditions are weighted more heavily than others, and, therefore, receive more points toward the hospital’s total HAC score.

“The weighting of measures CMS gives different HACs makes it possible that a hospital which has an overall greater total number of patient harm events can be ranked higher than one whose HACs fall under the more heavily weighted hospital harm events such as sepsis,” said Shipp.

“Without timely treatment, severe sepsis and septic shock can rapidly cause tissue damage, organ failure and death, which is why it’s one of the patient harm areas our network has been working hardest on trying to reduce,” said Shipp.

According to the CDC, more than 1.5 million people get sepsis each year in the U.S.; about 250,000 Americans die from sepsis each year; and one in three patients who die in a hospital have sepsis.

Sepsis occurs when an infection the patient already has in the skin, lungs, urinary tract or elsewhere triggers a chain reaction throughout the body. The most frequent germs that cause infections that develop into sepsis include: Staphylococcus aureus (staph); Escherichia coli (E. coli); and some types of Streptococcus.

“We also focus on antimicrobial stewardship, which includes closely monitoring multi-drug-resistant organisms such as Methicillin-resistant Staphylococcus aureus (MRSA) and preventing their spread in hospitals,” said Shipp.

“Initially, these germs were treatable with antibiotics, but over time, they became resistant, which makes them hard to manage and potentially life- threating.”

While MRSA is resistant to most drugs, it can respond to certain medications administered intravenously such as vancomycin or other antibiotic drugs in its class. Less severe staph skin infections can be treated by health professionals through draining any abscesses or boils.

Another area HAP’s program is focused on is device associated-acquired infections.

“Central line associated bloodstream infections, which occur when bacteria or other germs enter the patient’s bloodstream intravenously through tubing that delivers medicines, urinary tract infections through Foley catheters and ventilator-acquired pneumonia are some of the core areas where CMS provides funding for improvement,” said Shipp.

“HAP or other industry partners across the state we contract with have project managers who focus on improving the care in these specific areas by looking at best practices for preventing device-associated infections, and then disseminating that information to hospital personnel.

“For catheter UTIs, we have an infectious disease RN, who gets national speakers to talk on webinars for participating hospitals.

“They also do one-on-one coaching calls where they will talk directly to someone in the quality department at the hospital, and if it’s necessary, make a site visit.

“For example, for sepsis, we have a physician who is sepsis champion, and he and the team here go out and go to a hospital and talk to their team there and go through their process and protocols and see how they can offer some insight on how to make improvements or reinforce a good aspect of the hospital’s process.”

Shipp is optimistic that HAP’s HIIN program and others like it across the country will help hospitals to continuously improve.

“I’m encouraged by the improvement Pennsylvania hospitals have shown over the past year especially since when this penalty started it remained relatively unchanged,” said Shipp.

“This past year, that 18 percent reduction is showing that the patient care being provided has improved, and it’s only a smaller portion of the hospitals that are receiving penalties, so we’re moving in the right direction.”

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