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Treating patients of biological and chemical attacks can pose a different kind of challenge for hospitals from a risk management perspective, Jim Bentley, senior vice president of the Chicago-based American Hospital Association, recently told members of the American Society for Healthcare Risk Management (ASHRM).
Speaking in Boston at ASHRM’s annual meeting, Bentley said changes to triage procedures for treating mass casualties from such attacks could create new areas of liability. For example, he said, it might be necessary for health care providers to give treatment priority to the most survivable patients. Bentley said hospitals should include risk management in the preparation of disaster preparedness plans.
The long-awaited proposed rule on payment for the emergency department (ED) observation services from the Baltimore-based Centers for Medicare and Medicaid Services (CMS) has been published, and you probably will be pleasantly surprised at the outcome. "The [CMS] ruling was in our favor," announces Sandra Sieck, RN, director of cardiovascular development at Providence Hospital in Mobile, AL. "Now we can provide better patient care without financial restraints."
The rule proposes to create a new payment group for observation services for patients with chest pain, asthma, and congestive heart failure. The proposed ruling was published in the Aug. 24, 2001, Federal Register. The final rule will become effective Jan. 1, 2002.
Raymond D. Bahr, MD, FACP, FACC, president of the Baltimore-based Society for Chest Pain Centers and Providers, reports that the group got CMS's attention by building a consensus among a dozen groups, including the Irving, TX-based American College of Emergency Physicians. "At an early stage, we were able to engage [CMS] administrators who wrote the previous outpatient regulation," says Bahr, who is also medical director of The Paul Dudley White Coronary Care System at S. Agnes HealthCare, also in Baltimore. "We made them aware of the medical advances which have taken place in the care of patients with acute coronary syndrome."
He gives the example of current chest pain evaluation in the ED, which includes an "attack" approach for patients with acute myocardial infarction (AMI), but also an observation period to assess other patients. "This approach provided evidence for reduction in a number of missed AMI patients being sent home, as well as a significant reduction in the number of inappropriate admissions to the hospital," he adds.
This system of risk stratification was included in the new American College of Cardiology/ American Heart Association for patients being evaluated with unstable angina and non-ST- segment elevation myocardial infarction, he notes.1 To use this approach effectively, EDs needed to have appropriate reimbursement, Bahr urges. Although observation centers have been declining due to lack of reimbursement, Bahr expects that to change.
"With the proper reimbursement, we expect to see a renewed interest in observation services that will result in exponential growth of chest pain centers," he says. Bahr predicts that the number of chest pain centers, currently 1,300, will double over the next year or two.
1. ACC/AHA Guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive Summary and Recommendations. J Am Coll Cardiol 2000; 36,:970-1,062.
The latest edition of PacifiCare Health Systems Quality Index physician and practice report card shows patients are making use of the data the system provides to consumers. The report card rates groups in more than 40 specific areas, from patient safety to affordability. Preventive health screenings, access, and patient satisfaction data are provided for participating medical groups.
According to the company's vice president and corporate medical director, Sam Ho, MD, better-performing groups in California attracted 30,000 more members than those who didn't score as well — a membership gain that represents $18 million in increased revenues as a reward for improved quality.
Ho says that since its inception in 1998, scores have risen in areas such as breast cancer screening, diabetic care, and treatment for heart disease. "We've also seen improvements in many service measures, including patients' satisfaction with primary care doctors and decreased complaint rates about doctors as well. In fact, quality results for 18 of 26 measures have shown substantial improvement throughout the provider networks."
PacifiCare plans to expand the Quality Index profile to Arizona, Colorado, Nevada, Oklahoma, and Texas next year, and to include new measures profiling the performance of hospitals throughout its network. PacifiCare of Oregon and PacifiCare of Washington issued their first profiles last winter and plan to release their fall 2001 editions later this year.