Hospital Proves That Improved ICU Quality Saves Dollars

Sentara Williamsburg Regional Medical Center (SWRMC) has gone 5 years and hopes to celebrate its 6th year of no ventilator acquired pneumonia (VAP) cases in its ICU. This experience puts SWRMC in the top 10% of hospitals nationally in VAP experience. SWRC's ICU costs are $6,000 less that other comparable hospitals.

VAP is the second most common hospital acquired infection and the most common in ICUs.

This achievement is due to managing length of stay and ventilator days through:

• Screening protocols which result in fewer patients being put on ventilators in the first place
• Implementing the Institute for Health Improvement's ventilator bundle
• And, as The Leapfrog Group requires, using a dedicated intensivist (a physician specially trained in critical care medicine) in the ICU.

SWRMC's experience shows that better quality does indeed cost less. Employers have a vested interest in whether or not hosptials implement these types of process improvements as these improvements result in better care for the patient and cost the patient and employer less. MBGH is the Regional Roll Out leader for The Leapfrog Group here in Memphis. Employers should continue to push, through MBGH, for these types of improvements so we too can benefit here in Memphis.

Click here to read the article.

DOL Fact Sheet on New COBRA Premium Subsidy Program

The Department of Labor just released a fact sheet on how the 2010 Defense Appropriations Bill affects COBRA Premium Subsidies.

Click here to see the Fact Sheet.

COBRA Coverage & Subsidies Extended

From USA Today: "President Obama has signed legislation that will allow laid-off workers to receive subsidized COBRA premiums for up to 15 months. Previously, the subsidy expired after nine months.
The extension, included in a defense spending bill approved by Congress over the weekend, also extended the cutoff for eligibility for the COBRA subsidy to Feb. 28, 2010, from Dec. 31."

Click here to read the entire article.

Medical Center Chief Medical Officer Proud to Be a Leapfrog Top Hospital

Dr. Jonathan Gottlieb, Chief Medical Officer at University of Maryland Medical Center, talks about why UMMC is proud to be one of The Leapfrog Group's Top Hospitals for the fourth straight year. It is wonderful to have a major medical center accept the challenge Leapfrog has issued to "trigger giant leaps" in the safety, quality and affordability of health care.

Memphis area hospitals have been national leaders in reporting to The Leapfrog Group's annual Hospital Survey and we have seen progress in the adoption of computerized provider order entry and in staffing intensive care units with physicians trained in critical care medicine. But we still have a long way to go to have a hospital included in Leapfrog's Top Hospital list.

MBGH is challenging Memphis-area hosptials to have at least one hospital on this list in 2011. Let's see which hospital(s) step up and accept the challenge!!

Click here to view the video.

Long List of Concessions Needed To Ensure Passage of Health Reform

Many concessions were made in the final hours to get the 60 votes needed to pass Reid's health reform package in the U.S. Senate. Concessions ranged from:

• Federal funding of extra costs due to Medicaid expansion in certain states
• Exempting certain health plans in specific states from new fees
• Funding the construction of a new hospital
• Exempting certain industries from the new "cadillac plan" taxes
• Special Medicare Advantage benefits in specific states 

Click here to read more details.

Memphis Medical Society Quarterly Magazine Reports on MBGH's eValue8 Project

Read the Winter 2010 edition of the Memphis Medical Society Quarterly magazine's highlights of the results of MBGH's 2009 eValue8 health plan evaluation, starting on page 8 of the pdf.  Click here for an on-line copy of the magazine.

We're Likely to Continue to See a Decline in Small Physician Practices

Atul Gawande's latest article in the New Yorker magazine compares the current health care quality and efficiency crisis to a similar crisis experienced in agriculture in the early 1990s. Gawande points out that improvements in agriculture, driven by scientific and technological advances and evidence-based efficiencies, resulted in farm consolidation and the rise of big "agribusiness". And, the small farmer suffered as they became less competitive with larger, consolidated farms.

Gawande postulates that small physician practices may face a similar situation. Pressures for physicians to consolidate will only increase with the emphasis on performance measurement and outcomes-based payment methologies.Given this direction, we are likely to see the number of small practices continue to decrease.

Click here to read a summary of the article's points on small physician practices.

Click here to read Atul Gawande's complete article.

Senate Democrats Making Progress on Health Reform Legislation

Key new elements of the reform legislation Senate Democrats are sending to the Congressional Budget Office for scoring include:

• Opening Medicare beginning at age 55
• Non-profit national plans administered by the Federal Office of Personnel Management
• Requirements that insurance companies spend 90% of the premium on medical benefits (vs. administrative costs)

These new elements were negotiated by a group of 10 Democrats -- 5 liberal & 5 moderate -- in closed door negotiations. The plan is now being sent to the Congressional Budget Office for scoring and more details will be available once CBO releases their findings.

Technically, the "public option" is off the table, although the term may still be used to describe the expansion of Medicare or the national non-profit plans. However, the public option as originally envisioned appears to be gone.

Click here to learn more.

Mercer Survey Shows Employers Would Cut Benefits to Avoid Excise Tax

Mercer surveyed 465 employer health plan sponsors to find out how they would respond to the excise tax portions of the proposed health reform legislation. Major findings included:

63% indicated they would cut benefits to avoid paying the excise tax. 23% indicated they would pass the tax on to their employees.

75% of those that would cut benefits would do so by increasing employee deductibles and copayments.

52% of all respondents (small, medium & large employers) favor an individual mandate. 65% of large employers (5,000+ employees) favor an individual mandate.

Click here to get more detailed survey results.

Memphis Firms Await Health Reform Scenarios

MBGH's board member, Jane Pienaar of Morgan Keegan, is highlighted in this article covering MBGH's November 24 health reform meeting with Andy Webber, CEO of the National Business Coalition on Health. The title says it all: "Firms await health reform scenarios" before they make strategic changes...

Click here to read the Commercial Appeal article.

No Memphis Hospitals on Leapfrog's Top Hospital List

No Memphis hospitals are on The Leapfrog Group's Top Hospital list for 2009. Only TN hospitals were Vanderbilt University Hospital and The Monroe Carell Jr. Children's Hospital at Vanderbilt. I'm challenging Memphis hospitals to have at least one of our hospitals on this list by 2011. Which hospital(s) want to help make this happen?

Click here to see the entire list of Top Hospitals.

Confused Over the New USPSTF Recommendations on Screening Mammorgraphy?

There has been a lot of media coverage and confusion over the change in the U.S. Preventive Services Task Force recommendations on screening mammography. To get the complete and accurate story, click here to read the full recommendations and rationale for the change.

A summary of the recommendations is presented below, including a quote from Diana Petitti, MD, MPH, Vice Chair of the USPSTF before U.S. Congress on November 19, 2009.

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (emphasis added).
Grade: C recommendation. (The USPSTF recommends against routinely providing the service)

"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values."
Diana Petitti, MD, MPH
Vice Chair, U.S. Preventive Services Task Force
November 19, 2009

* The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
Grade: B recommendation. (The USPSTF recommends the service)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
Grade: I Statement. (Insufficient evidence)

* The USPSTF recommends against teaching breast self-examination (BSE).
Grade: D recommendation. (The USPSTF recommends against the service)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
Grade: I Statement. (Insufficient evidence)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Grade: I Statement. (Insufficient evidence)