ANA Recommends APRNs be Included Providers in Plans on Insurance Exchanges

The American Nurses Association (ANA) has recommended to the Centers for Medicare & Medicaid Services (CMS) that health insurers looking to offer plans on state health insurance exchanges include a certain number of advanced practice registered nurses (APRNs) in their network of health care providers for the plans to qualify. Given the millions of uninsured and underinsured individuals that seek primary care through these exchanges and the fact that research continually demonstrates that APRNs provide safe, high quality patient care, the ANA maintains that private insurers should not continue to exclude APRNs from their networks of providers.

To learn more, check out this recent story on the Advance for Nurses site.

Hospitals Try To Control Readmissions, Even When It Hurts Profits

Yesterday, Fred Mogul, of WNYC, in collaboration with NPR and Kaiser Health News, reported how hospitals nationwide have implemented a variety of programs to curb costly readmissions. Starting in the fall of 2012, the Department of Health & Human Services is planning to begin penalizing hospitals for readmissions for patients discharged after experiencing heart attacks, heart failure or pneumonia. With one in five Medicare patients being readmitted to hospitals within 30 days of their initial discharge and research suggesting that 75% of these readmissions are preventable, hospitals have adopted care programs that aim to curb readmissions, improve transitional care from acute care facilities to the patient's home, and help the hospital avoid penalties from the HHS.

Click here to read the full news article.

Reflecting On Dr. Berwick's Tenure As CMS Administrator

In this month's edition of Health Affairs, Harris Meyer wrote a fascinating piece reflecting on Dr. Don Berwick's short tenure as the head of the Center for Medicare & Medicaid Services (CMS). In the article, Ms. Meyer discussed the praise Dr. Berwick's body of work at the CMS received from numerous professional organizations and highly respected health leaders.

Click here to read the Health Affairs article (freely available to all).

A New Tool to Compare Hospital Performance

Last week, Tom Avril and Dylan Purcell, of the Philadelphia Inquirer, reported on the Center of Medicare & Medicaid Services' hospital performance measurements for Philadelphia area hospitals. The Inquirer has created its own health portal for Philadelphia area residents to obtain performance data on eight serious, generally preventable conditions that may influence which facility they chose to obtain health services from when necessary.


Click here to access the Philadelphia Inquirer's hospital performance data.

Click here to read the news article regarding hospital performance measurements.

Click here to read more about INQRI teams' work addressing quality/performance measurement.

Click here to access the CMS hospital compare website.

HHS Partnership for Patients Initiative

Today, the Department of Health and Human Services announced their commitment to use $1 billion in new funding from the Affordable Care Act to meet two important patient safety goals:

1. Reduce preventable hospital injuries by 40% by 2013; and
2. Cut preventable hospital readmissions by 20% by 2013.

Patient advocate Sorrel King introduced HHS Secretary Kathleen Sebelius and Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, who announced the Partnership for Patients Initiative which will unite providers, health systems, insurers, patients and advocates around the goal to reduce medical errors.

As Administrator Berwick said, we have the best trained and best equipped health workforce. The safety issues facing our health care system are indeed system-oriented. As we work to develop new processes and improved systems, we believe that nurses can and should be at the forefront of the discussion.

As recently articulated in the Institute of Medicine report on “The Future of Nursing: Leading Change, Advancing Health,” nurses are integral to promoting health and preventing medical errors in hospitals, clinics and everywhere patients are treated. The recommendations in the report are a testament to the value of nurses in ensuring patient safety. The recommendations encourage interprofessional collaboration and patient-centered teams that incorporate the skills and talents of all health professionals.

Infusion Nurses Keep Patients Safer, Help Reduce Healthcare Costs

The Centers for Medicare & Medicaid Services (CMS) has made reducing hospital-acquired infections a priority by refusing to reimburse hospitals for the treatment of such infections. Nurses who specialize in infusion therapy are the individuals who provide the proper dose of medication and keep patients safe from catheter-related bloodstream infections. As they have been recognized for the past three decades, on Tuesday, January 25th, infusion nurses will be honored for their accomplishments on 'National IV Nurse Day'.

Click here to read the article.

Click here to read a similar study conducted by an INQRI grantee alumnus.

Group Launches Online Tool to Help Nurses Avoid 'Never Events'

Health care information services provider Elsevier has developed an online tool designed to help nurses prevent the 10 "never events" identified by the Centers for Medicare and Medicaid Services (CMS), Healthcare IT News reports. The tool, which will be available on Elsevier's Mosby's Nursing Consult Web site, was developed in response to a CMS decision in 2008 to cease reimbursing for adverse events that could have been prevented if specific evidence-based protocols had been followed. To create the tool, Elsevier researchers paired each of the 10 never events with the relevant articles, reports, monographs and studies. Nurses can use the tool to search for a never event and review a complete definition, evidence-based nursing content, book excerpts, journals, guidelines, patient education, images and relevant news. Elsevier's online tool includes information on all 10 never events, including catheter-associated urinary tract infection, foreign objects retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, manifestations of poor glycemic control, vascular catheter associated infection, surgical site infection and deep vein thrombosis/pulmonary embolism. In addition, the online tool includes decision-making guidance for six conditions—including delirium, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, Legionnaire's disease and iatrogenic pneumothorax—currently being considered by CMS for inclusion on the never events list. According to the president of Mosby MCS, a business unit of Elsevier Health Sciences, "nurses have a powerful role to play in ensuring that hospitals are paid appropriately for their services," and the company is "proud to support nurses in improving the safety and quality of care they provide, not just to Medicare patients but to all the patients and family members they treat and care for." (Manos, Healthcare IT News, 8/11/09)


(c) RWJF, 2009

Children's View on Quality Should be Considered

Early in his term President Barack Obama signed into law the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA promised a “new day for children’s health care quality” and launched a new coordinated effort from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) to implement its quality provisions.

Today, AHRQ’s National Advisory Council for Healthcare Research and CMS’s Quality Subcommittee on Quality Measures for Children’s Healthcare in Medicaid and Children’s Health Insurance Programs (CHIP) are holding a two-day meeting (July 22-23) on healthcare quality and research on issues related to pediatric care. This inaugural meeting is an exciting step forward in the implementation of CHIPRA and pediatric quality measures, an issue that two INQRI grantees have researched extensively.

Nearly half of the 7.6 million children hospitalized every year in the United States are over age 6, yet no one ever systematically asks these children about their hospital experiences or the quality of care they have received. Instead they turn to their parents to answer for them.

Columbus Children’s Hospital researchers Nancy Ryan-Wenger and William Gardner say too often children are the “silent consumers of care.” Their INQRI research of hospitalized children has shown that seeking answers from parents is not an accurate measure of children’s perceptions of their care. In fact, children prioritize an entirely different set of factors when rating their hospital experience. The graph below shows that while only about 10% of parents view “check on me often” as an important factor in the care of their children, children see this as a very important measure of their care. And, the list goes on from there.

Through their research, Ryan-Wenger and Gardner are hoping to improve the reliability of tools to measure children’s health care, an effort that has great implications for changing nursing practice and improving care. Why are children’s perceptions important? Early experiences with medical care can greatly impact future decision-making about seeking care. It can even influence future career decisions in a time when bringing new nurses and doctors into the system is essential and becoming increasingly important to the success of American healthcare.

Ryan-Wenger and Gardner recommend both adding a “quality of care from the hospitalized children’s perspective” component to existing nursing sensitive indicators and working to develop and implement a standard, reliable measure of a “children’s hospital experience scale.” They provide a sample concept, reproduced below.

As AHRQ and CMS meet with stakeholder groups this week on pediatric healthcare quality measures, they must acknowledge the difference between parents’ and children’s views of care and take that into account. There are ubiquitous surveys seeking patient views on hospital care but there are no surveys that ask children to answer directly. Ryan-Wenger and Gardner say this has to change because children’s opinions matter.

For more on Ryan-Wenger and Gardner’s study, please click here.

NICHE Web Based Learning Series Presents: "The Never Events Series: The Experts Respond"

Followers of this blog may be interested in an upcoming web event sponsored by NICHE:

The Never Events Series: Focus on Physical Restraints

For the past 15 years, U.S. regulatory and accrediting agencies have launched major initiatives aimed at restraint reduction/elimination in all health care settings, including hospitals. Despite these regulatory pressures, physical restraint use remains a common practice, especially in critical care settings. As a CMS regulated hospital condition of participation, there is financial imperative to reduce physical restraint use, while maintaining patient safety and preventing avoidable complications. Drs. Minnick and Mion will host a detailed discussion of how to utilize evidence based best practices to reduce physical restraints within acute care settings.
Drs. Minnick and Mion have collaborated extensively on research specific to physical restraint use in hospital settings. Their authoritative work has informed current understanding of the influence of patient characteristics, care processes, work force and environment and administrative factors upon practices related to the use of physical restraints.

Ann Minnick, PhD

Ann Minnick, PhD, RN, FAAN is the Associate Dean of Research & Chenault Professor of Nursing at Vanderbilt University School of Nursing (VUSN). Internationally recognized as an accomplished health services researcher, Dr. Minnick is also Director of the Center for Research Development and Scholarship (CRDS) at VUSN. Additionally, she serves on the National Advisory Council on Nurse Education and Practice (NACNEP). Dr. Minnick has led numerous national grants that have influenced the environment of nursing practice and has consulted with education and service institutions as well as state, federal and international projects. Her current research concerns are issues related to health service delivery, nursing human resources and patient-centered care.

Lorraine Mion, PhD

Lorraine C. Mion, PhD, RN, FAAN is the Independence Foundation Professor of Nursing at Vanderbilt University School of Nursing. A nationally recognized nursing researcher, she has helped shaped health care practices and policies related to the hospitalized older adult by involvement in the Joint Commission Task Force on Physical Restraints and as an adviser to the Society of Hospital Medicine for Geriatric Care. Her research and practice has focused on hospital-based interventions to minimize use of physical restraints in non-psychiatric settings and identification of risk factors (patient-, nurse- and unit-level) for patient-initiated therapy disruption in critical care settings. A senior advisor to the NICHE program at the New York University College of Nursing NICHE program, she continues to provide consultation on program and resource development, as well as essential, ongoing support to both senior and fledgling NICHE sites.

Click here to register.

Tuesday, July 21, 2009 Time: 1:30 p.m. - 2:30 p.m. EST

NICHE Sites $89 per phone line (Discount Code:nich09jul)
Non-NICHE Sites $99 per phone line