QUALITY: It's About BETTER Health Care, Granny

When you have a chance, get the grandparents away from watching those blood-pressure raising town halls on their televisions, and tell them this. Health reform is not about chopping Medicare. It's about making it better. And saving lives.

A test program now in its fourth year has shown how it can work. Hospitals that do a great job get rewarded. Those with a poor performance, get penalized. 

Premier, Inc., a health care alliance based in North Carolina, released the results of year four of their landmark Medicare demonstration project this week. You might remember last year I blogged about year three, one of the first instances of a pay-for-performance initiative enforcing financial penalties on low-performing providers. I even got a tiny mention on Modern Healthcare (free registration required).

Year four again brought good news about higher quality. BNA says:

HC4HCR: Checking In With Ascension, Denver Health

This week, Kaiser Health News shined the spotlight on two high-performing health systems. KHN talked to Ascension Health President and CEO Anthony R. Tersigni, EdD, FACHE, and Denver Health CEO Patricia A. Gabow, MD, about the current health care reform debate, and what reform will mean for their health systems.We've highlighted both these health systems on this blog (here, here, here). Read more about them on the Health CEOs for Health Reform site.

Ascension Health is the nation's largest Catholic and largest nonprofit health care system, with over 60 hospitals in 20 states and the District of Columbia. Ascension Health serves patients through a network of services, including acute care services, long-term care, community health services, psychiatric, rehabilitation and residential care.

HC4HR: A New Model for Accountable Care

Recently we had the chance to sit down and talk with Donna Katen-Bahensky, the president and CEO of University of Wisconsin Hospital and Clinics and a member of Health CEOs for Health Reform.

In the video below, Katen-Bahensky describes her organization's efforts to change the dynamics of modern medicine through the principles of accountable care organizations (ACO).

QUALITY: More Quality Improvements at Providence Medical Center

We wrote recently about Providence Medical Center in Everett, Washington, and itsr innovations in health care quality. Everett now gets a look as one of "10 model communities throughout the USA able to provide top-notch care at relatively low prices" writes USA Today.

Over the past five years or so, the hospital expanded the leadership role of physicians to promote consistency and quality in care delivery, and in trying to address all the things that can go wrong when a patient transitions from one care setting, or care provider, to the next. . USA Today highlighted another one of Providence's quality innovations, shortening length of hospital stay and improving patient satisfaction during and after heart surgery. That involved re-examining care transitions too.

Providence is one of the few U.S. hospitals to create a "single-stay" heart surgery unit so patients remain in one place from the moment they leave the operating room until they're discharged. As patients need less life-support technology, it's simply removed from the room.

QUALITY: Revisiting Readmissions

We wrote about the high rate of hospital readmissions recently on the blog and for The Washington Post/Kaiser Health News. Today, both the Wall Street Journal and NPR examine the problem, both focusing (as we did) largely on older people with heart disease.

NPR's Joseph Shapiro told the story of Jessica MacLeod, a nurse with advanced training at the University of Pennsylvania Health System in Philadelphia. (We've written about Penn's Mary Naylor and their Transitional Care Model, too, here and here). MacLeod gets to know her patients in the hospital, and then follows them at home for  two or three months, with particular attention to those first 48 hours when lots of things can go wrong.

One of her patients is Ken Rogers, 80, a retired superviser at a printing company. He recently spent a week in the hospital after experiencing chest pains.When he was hospitalized in the past, he recalled, "when I came out of the hospital, you go, 'Yeah? What do I do now?' It was, 'See ya,' " This time MacLeod was at his home within a day, and she returned often.

QUALITY: Stopping the Mistakes

All health systems, even good ones, make mistakes. Some have horror stories. Surgical sponges left inside of patients, deadly infections that come from within the hospital rather than the outside world, operations on the wrong body part. Within the past few years, Virginia, Maryland, and DC have enacted laws requiring hospitals to disclose such patient injuries to regulators, The Washington Post reports. The goal is to make the system safer.

Regulators are hoping to reduce preventable deaths and injuries, sometimes called "never events" because they should "never" happen. According to the Post, one hospital in Northern Virginia reported about two dangerous blood infections for every 1,000 IVs inserted in patients. Currently, insurance companies generally reimburse hospitals for medical errors. If, for example, a patient were to come into the hospital for a low cost procedure, and get an infection from an IV because their doctor did not wash his hands, the hospital would bill the insurance company for the much higher cost of treating the hospital acquired infection. As the Post puts it, "if a lawn service mowed down your rosebush while cutting the grass, you wouldn't pay the company to replace it."

COST: Emergency Room Utilization on the Rise

Americans are still feeling the effects of the recent economic recession. Many who have lost their jobs have also lost their health care coverage, leaving hospital emergency rooms inundated with people seeking care, according to the Washington Post.

This year, DC's Providence Hospital reported emergency room visits increased by 13 percent. Larry Gage, president of the National Association of Public Hospitals and Health Systems, told the Post, "The absolute number of people using emergency rooms has gone up as much as 20 to 30 percent in the last six to eight months due to the recession and people losing their jobs. The only option in their minds is going to the hospital."

This trend is visible not just in DC and the surrounding area, as the Post reports, but across the nation. Back in April, the American Hospital Association reported that approximately 60 percent of hospitals were seeing more uninsured patients in their ERs, and 70 percent of hospitals were seeing higher rates of uncompensated care.

COST: White House Announces Deal With Hospitals to Save $155 Billion

At a press conference this morning, Vice President Joe Biden formally announced that deal you've been hearing about with the hospitals, who have agreed to forego about $155 billion in government payments over the next 10 years. That only happens if health reform happens -- but the deal itself will help health reform happen.

Biden and HHS Secretary Kathleen Sebelius were joined by representatives from the American Hospital Association, the Hospital Corporation of America, Community Health Systems, and the Catholic Health Association of the United States.

"The very groups we have been talking to have been the most vocal opponents of health care reform; they are now becoming the vocal proponents for health care reform," White House chief of staff Rahm Emanuel told the New York Times.

HEALTH REFORM: Hospitals To Provide $155 Billion In Savings

In a deal expected to be officially announced on Wednesday, July 8, the U.S. hospital industry has agreed to provide $155 billion in savings to help pay for health care reform, Ceci Connolly and Michael Shear write in today’s Washington Post.

The agreement, reached between the White House, the Senate Finance Committee, and three major hospital groups, calls for the savings to be phased in over a ten-year period. From The Post:

Most of the savings—about $100 billion—would come through lower-than-expected Medicare and Medicaid payments to hospitals, said the two industry sources. About $40 billion would be saved by slowly reducing what hospitals get to care for the uninsured, they added. The reductions would probably not begin for several years after a significant number of people have enrolled in the new insurance programs.

HEALTH CARE: Stopping the Revolving Hospital Door

Not a lot of aspects of U.S. health care still have the power to stun me, but when I first heard the statistics on U.S. hospital readmissions I was, well, stunned. I wrote about readmissions in today's Washington Post (in a collaboration with the new Kaiser Health News.) Readmissions is a pretty sprawling topic, but I think the reason it interested me so much is because it's a nexus of so much of what's wrong with our health care system. Errors of omission and commission. A system so complex and fragmented that we lose track of what the patient needs. Financial penalties (in some although not all cases) for hospitals that try to make things better.

For a Medicare patient who has been hospitalized, about one in five are rehospitalized in 30 days, one in three within 90 days. Within a year, two-thirds are either rehospitalized, or dead. For younger patients, the figures are better but not great. After all, don't we all have friends and family who have gotten out of the hospital and headed right back in again a week, two weeks, a month later?