Cooperating for better care.

Ashish Jha

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Should standards be lowered for safety-net hospitals?

 

The federal government sometimes withholds money from safety-net hospitals because they fail to meet certain standards.

A piece in governing.com asks whether those standards should, at least in some cases, be lowered.

Penalties “handed down by CMS are part of the Affordable Care Act {and} are meant to motivate hospitals to correct procedures so as to avoid patient safety violations. But the problem with these penalties, some health policy experts say, is that they don’t take into account the particular challenges that individual hospitals face.”

“Most of the penalized hospitals take care of the poorest and sickest,” Ashish Jha,  M.D., a  Harvard professor who focuses on patient safety, told the news service.

“Jha and others argue that CMS should add a risk adjustment factor. Until then, safety-net and academic-centered hospitals {with the most challenging patients} will continue to get slapped with the most penalties.”

“Adding to the hospitals’ exasperation is the fact that there is little information about whether the penalties have actually improved health outcomes.”

To read the piece, please hit this link.

 


JAMA study gives good marks to VA hospitals

VAcard

Card used to obtain VA care.

Despite occasional controversies, veterans’ hospitals compare  favorably with others in treating older men with three common conditions — heart attacks, heart failure and pneumonia, says a study on death rates and readmissions.

The study, in the Journal of the American Medical Association, said that chances of dying or being readmitted within 30 days of treatment for those conditions varied only slightly  between patients hospitalized within the VA system and outside hospitals.

The Associated Press reported that the results contrast with news stories  about quality questions and long waits for care. They suggest that VA hospitals “are still able to deliver high-quality care for some of the sickest most complicated patients,” Ashish Jha, M.D., a Harvard health-policy expert, said in an editorial published with the JAMA study.

At VA hospitals, death rates were marginally lower after a heart attack — 13.5 percent vs 13.7 percent for outside hospitals; and for heart failure — 11.4 percent vs 11.9 percent. They were slightly higher for pneumonia — 12.6 percent vs. 12.2 percent at non-VA hospitals.

Readmission rates ranged from about 17 percent to 25 percent for the three conditions and were highest at VA hospitals, but only by about 1 percentage point or less.

“Both groups are now working on quality in ways they didn’t a decade ago and the levels of good performance are quite comparable” for the conditions studied, said lead author Harlan Krumholz,  M.D., a Yale University cardiologist and researcher.


Lethal variability in surgical outcomes

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An analysis shows that the probability of surviving any of four high-risk surgeries can vary by as much as 23 percent depending on the hospital,  Reuters reported today.

The report is by the nonprofit Leapfrog Group, a patient-safety organization supported by large employers, and Castlight Health Inc, which sells software for employers to manage healthcare spending.

Ashish Jha, M.D., of the Harvard School of Public Health, who was not involved in the Leapfrog report, told Reuters. “It’s amazing there is such variability in mortality from these common surgeries, and patients should know that.”

”Leapfrog asked 1,500 hospitals for 2013 data on four risky surgeries, including number of procedures and patient deaths. It adjusted the numbers to come up with a ‘predicted survival estimate for each,” Reuters reported.

”For pancreatectomy (removing all or part of the pancreas, usually to treat cancer), predicted survival rates ranged from 81 percent to 100 percent. Of 487 hospitals reporting data, 203 had rates of at least 91.3 percent, which Leapfrog chose as the benchmark for quality.”

”For esophagectomy (removing all or part of the esophagus), expected survival ranged from 88 percent to 98 percent. Only 182 of 535 hospitals had rates of at least 91.7 percent.”

”For repairs of abdominal aortic aneurysm, survival ranged from 86 percent to 99 percent; 268 of 792 hospitals met the benchmark of 97.3 percent.”

”For replacing the heart’s aortic valve, survival ranged from 92 percent to 97 percent; only 95 of 544 hospitals hit 95.6 percent.”

”The study didn’t analyze which kinds of hospitals – nonprofit or for-profit, in one region or another – excelled, but in general those that performed more procedures did best. National stalwarts such as Brigham and Women’s Hospital in Boston and the Mayo Clinic in Rochester, Minn.,  did well in all four surgeries, but so did Hoag Memorial in Newport Beach, Calif. and Morristown Medical Center, in New Jersey.”

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Boardrooms and patient care

board

A piece by Austin Frakt on The New York Times Web site discusses how hospital board rooms are as important as operating rooms in patient care.

But, “'{B}oard members are community leaders, serving on the board to support fund-raising goals,’  Ashish Jha, a Harvard physician, told Mr. Frakt. “They don’t think it’s their job to hold management accountable for performance. Board members often feel like clinical quality is physicians’ jobs, and they don’t want to step on doctors’ toes.”

”The trouble with this perspective is that boards, and other hospital management, can influence care in ways that individual physicians cannot. They can promote protocols that ensure that crucial information is conveyed to the right people at the right time. They can establish systems so that equipment and supplies are available when needed. They can set expectations for a culture of high performance, not just from individuals but from teams of them that must work together. And they can require quality to be monitored against goals with incentives to push it toward those targets.”


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