News briefs

Success factors noted for ED patient flow

Eight common factors were identified as critical for success in improving patient flow in the nation’s emergency departments (ED) in a report from the Urgent Matters Learning Network, a national initiative of the Robert Wood Johnson Foundation. Ten hospitals were selected to participate in the initiative to help hospitals eliminate ED crowding and communities understand the challenges facing the health care safety net.

Practical management tools developed 

The Urgent Matters team developed a series of practical management tools to address issues related to ED overcrowding. However, as the initiative evolved, hospitals participating in the Learning Network developed a variety of strategies designed to improve patient flow and reduce ED crowding and, in the process, created their own best practices. The report, Bursting at the Seams: Improving Patient Flow to Help America’s Emergency Departments, lists these critical success factors:

  • Recognizing that ED crowding is a hospitalwide problem, not an ED problem.
  • Building multidisciplinary, hospitalwide teams to oversee and implement change.
  • Determining the presence of a champion, an individual in a well-respected position who sells patient flow improvement to the medical staff and executive management.
  • Guaranteeing management’s support.
  • Using formal improvement methods.
  • Committing to rigorous metrics. (Data collection is an absolute requirement, the report says.)
  • Making transparency an organizational value. (Sharing outcomes and results with all involved staff builds ownership and accountability, the report says.)
  • Finding the right balance between collaboration and competition.

Proposed rule targets improper payments

States would be required to estimate improper payments to health care providers and insurers for Medicaid and State Children’s Health Insurance Programs under a proposed rule published by the Centers for Medicare & Medicaid Services (CMS). Also under the proposed rule, the state would have to identify "emerging vulnerabilities" that could be addressed to reduce such payments.

CMS said the estimates are needed to meet federal requirements to estimate improper payments in the programs because the programs are administered by state agencies according to each state’s unique program characteristics. The rule — which can be found at www.access.gpo.gov — proposes requirements for producing the annual estimates and reporting them to the Department of Health and Human Services, which would use them to produce a national estimate.

JCAHO hikes fees for hospital surveys

Hospitals will be charged about 10% more in fees for their triennial survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), beginning in January 2005. On average, hospitals will see a $2,700 increase in survey fees, and those with 200 beds or more will be assessed an additional $3,500 for a new surveyor — a health care engineer who will evaluate compliance with Life Safety Code and physical plant requirements..

Increases for other health care organizations range from 5% ($300) for critical access hospitals to 20% ($3,000) for health networks. JCAHO last raised its fees in 2000. The organization said it plans to allow accredited organizations to begin spreading their survey fees over the three-year accreditation cycle, starting in 2006. For more information, go to the organization’s web site at www.jcaho.org.

HMO profits soar from 2002 to 2003

The nation’s HMOs nearly doubled their profits during 2003 to $10.2 billion, an 86% increase from the $5.5 billion reported in 2002, according to an analysis by Weirs Ratings Inc. The company, which rates the financial strength of insurers, reviewed year-end data from 502 HMOs. "The industry’s soaring profits continue to irk both consumers and businesses who are shouldering skyrocketing health care costs without any perceived improvement in benefits," noted Weirs vice president Melissa Gannon, who said the next wave of consumer backlash may force HMOs to evolve their cost structures.

Almost all hospitals to get payment update

Nearly every eligible acute care hospital in the country has successfully shared data on the quality of care it provides and will receive a full Medicare payment update of 3.3% next year, the Centers for Medicare & Medicaid Services (CMS) has announced. Of 3,906 eligible hospitals, 3,839 (98.3%) met all of the CMS requirements and will receive the full annual payment update in fiscal year 2005. The remaining 67 hospitals chose not to submit the data.

Panel will certify electronic records

A panel appointed to certify electronic health records designed for use in the outpatient setting will have initial certification requirements and processes ready for testing by summer 2005. The Certification Commission for Healthcare Information Technology was appointed by the American Health Information Management Association, Healthcare Information and Management Systems Society and National Alliance for Health Information Technology to help ensure interoperability of health care information technology products with emerging local and national health information infrastructures. For more information, go to www.himss.org.

Reward efficiency from providers, report suggests

To slow health care cost increases, public and private health plans need to reward health care providers for quality and efficiency and better manage care for patients with costly conditions, according to a recent report by Commonwealth Fund president and economist Karen Davis. Consumer-directed plans, which are generally a high-deductible health plan combined with a health reimbursement account, are not likely to curb costs and could worsen health outcomes by reducing needed preventive care and care for chronic conditions, the report says. The report points out that 10% of patients account for 69% of health care costs. More information is available at www.cmwf.org.