Consent form, patient care subject of new study

Getting advanced consent for eight commonly performed procedures when patients were admitted to a hospital intensive care unit (ICU) significantly increased the frequency with which informed consent was obtained, without compromising the consenter’s comprehension of the process, according to a recent study.

Investigators reasoned that providing patients and their proxies with information about procedures at admission and obtaining consent for some of the procedures that might be performed would increase their understanding of those potential elements of care. Doing so also would allow a greater number of proxies to participate in important decisions regarding care, they theorized.

In the study, reported in the April 16 issue of the Journal of the American Medical Association, a university hospital gave patients and/or proxies a single consent form for eight common ICU procedures upon admission to the ICU, introducing physicians and nurses to the form during orientation to the unit. Handouts describing each procedure also were available in the ICU waiting area.

Under the new process, 90% of procedures were performed with consent, compared with 53% before, and the consenter’s comprehension of the indications and risks of the procedures remained high.

Interim rule issued for HIPAA penalties

An interim rule establishing procedures for imposing civil monetary penalties on entities that violate standards adopted under the Health Insurance Portability and Accountability Act’s (HIPAA) administrative simplification provisions has been issued by the Department of Health and Human Services.

The rule, published in the April 17 issue of the Federal Register, is the first installment of the department’s enforcement rule for the provisions. It informs regulated entities of the agency’s approach to enforcement. The rule was effective May 19, 2003, and expires on Sept. 16, 2004, when the final rule will be published.

Other upcoming HIPAA deadlines are as follows: Oct. 16, 2003 is the compliance date for electronic transactions and code sets. The National Employer Identifier was effective July 30, 2002, and covered entities must comply with the requirement by July 30, 2004. The Security Rule regulations will become enforceable April 21, 2005, for most covered entities, including hospitals. Small health plans will have an additional year to comply.

Hospital mergers down, recent study shows

Hospital merger activity declined significantly in 2002, hitting its lowest level in 10 years, according to a recent report by Irving Levin Associates based in New Canaan, CT.

In 2002, 58 hospital mergers or acquisitions involving 101 hospitals were announced, down from 83 transactions involving 118 hospitals, Irving Levin said. One transaction, the purchase of Health Midwest by HCA, accounted for more than 30% of the total $3.5 billion in deals transacted in 2002, the publisher said.

The number of hospital transactions declined 30% in 2002 and has plunged by more than 70% since peaking in 1997. Much of the decline in activity over the past several years reflects the diminishing role of nonprofit hospital organizations as buyers, according to the report.

Five years ago, the buyer in 75% of the hospital transactions was a nonprofit, compared with just 25% in 2002, according to the Health Care Acquisition Report.

Medical liability reform still needed, survey says

Legal reforms have slowed the growth of medical liability insurance premiums where they have been enacted, but federal reform still is needed, says a recent report in the on-line news service AHA News Now.

Medical liability expenses are twice as much for hospitals in what the American Medical Association has identified as "crisis states," according to a recent survey of 1,000 facilities by the American Hospital Association.

In these crisis states, the survey notes, medical liability costs are as much as $11,435 per staffed bed, compared with $4,228 in noncrisis states.

Commenting on the survey, Gerry Miller, president and CEO of Crozer-Keystone Health System in Springfield, PA, said, "Something is substantively wrong when a system like Crozer-Keystone spends more on insurance than on all the medications we buy for the patients we care for."

Jeff Curtis, president and CEO of H.S.C. Medical Center in Malvern, AR, said his hospital "had no choice but to discontinue delivering babies" because local physicians could not afford to pay their premiums. 

More help sought for rural hospitals

The Rural Community Hospital Assistance Act, introduced in late April by Sens. Ben Nelson (D-NE) and Sam Brownback (R-KS) could provide some relief for financially troubled rural hospitals.

The act enhances the Critical Access Hospital program, which provides special Medicare reimbursement for certain rural hospitals with 15 or fewer inpatient beds; helps rural hospitals with 50 or fewer inpatient beds by allowing them to use cost-based reimbursement instead of the prospective payment system; ensures that these hospitals will receive 100% compensation for treating Medicare patients who fail to supply their copay; and provides additional funding for technology and infrastructure needs.

The bill is a companion measure to H.R. 937, introduced by Reps. Jerry Moran (R-KS) and Jim Turner (D-TX) in February.

The legislation is part of AHA’s agenda of helping rural hospitals by establishing a more equitable Medicare area wage index and continuing better Medicare base payments for rural and other urban hospitals.

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LOS trending down, CDC survey explains

The average hospital stay was 4.9 days in 2001, the latest year for which data are available, according to a survey by the Centers for Disease Control and Prevention (CDC).

That figure, which is based on a survey of discharges for nonfederal short-stay hospitals in the United States, is the same as in 2000, but down from 7.8 days in 1970. The average length of stay as measured by the survey rarely changes dramatically year to year, but has been trending downward for all patients except children for the past three decades, CDC experts noted.

The most dramatic decrease in the length of stay has been for elderly patients, dropping from an average of 12.6 days in 1970 to 5.8 days in 2001. The average stay for children has held steady at around 4.5 days.

The rate of hospitalization for most conditions also has decreased over the past two decades. An exception is congestive heart failure, which has gradually increased by 62% for those 65 and older since 1980. CDC officials said the increase reflects the success in treating through drugs and surgery more acute forms of heart disease, such as heart attacks, thus extending the lives of many elderly people and making it more likely they will develop chronic heart problems.

For more on the CDC’s 2001 National Hospital Discharge Survey, go to