Just How Transparent Are You Willing to Be?
December 20, 2009
Posted by chcablogadmin in : Quality
Among the 5,000 or so participants in the Institute for Healthcare Improvement (IHI) annual meeting were about 100 people from our hospitals. We were all trying to absorb words of wisdom and best practices from the adult world.
Jim Anderson and I attended “Finding the Cost/Quality Sweet Spot,” a provocative session presented by James L. Reinertsen M.D. His theory: it is easy for a Board or staff member to say their BSI rate is 1 or 2 percent; removing the denominator yields a completely different message. He challenged hospitals to report in whole numbers such as: “Our hospital harmed 30 patients last year with blood stream infections that could have been prevented.”
Dr. Reinertsen went on to tell a story about a hospital CMO who started a meeting by simply flashing 514 up on the wall. When asked about the number, he replied that it was the number of patients they had harmed last year. Another hospital reported in storytelling fashion the name and description of harm done to each patient. He trended the report over time, telling how the number of patients harmed declined on a name by name basis.
Just how transparent are you willing to be? Please tell us your story about eliminating the denominator to bring home a stronger message of quality improvement.
add a commentChildren of Undocumented Immigrants Headed Without Coverage to Children’s Hospitals?
December 19, 2009
Posted by chcablogadmin in : Healthcare Reform
Today I googled a question: “Will the children of undocumented immigrants be covered in health reform?” I searched to see if anyone had calculated the burden placed on children’s hospitals as a result of excluding children of undocumented immigrants from coverage. Right now, children of undocumented immigrants are not covered by the Obama plan. So how many kids are we talking about? According to recent data by the Pew Hispanic Center, illegal immigrants and their children make up 17 percent of the uninsured people in the United States. Long-term CBO estimates predict that 17 million people will remain uninsured under the reforms of a House Bill, nearly half of them would be illegal immigrants.
Section 246 of HR Bill 3200 specifies that no federal payments will be made for undocumented immigrants. However, other than this section, undocumented immigrants are not specifically prohibited from receiving benefits under the health insurance reform plan. A door seems to have been left open! If left out of the once all encompassing plan, these kids will once again arrive on our door step with critical healthcare needs.
It strikes me as interesting that undocumented children have not drawn more attention in the press or from the national lobbying groups. It will cost our hospitals millions of dollars to cover this population! Perhaps it’s time for a few more targeted responses from our hospitals to ensure that coverage of this population is included under health reform.
add a commentChildren’s Hospitals Tagged With High Mortality
December 6, 2009
Posted by chcablogadmin in : Quality
- Rick Merrill
That great statistician Florence Nightingale returned from the Crimea 150 years ago and instituted the first comparative audit of deaths in London hospitals, but in 1863 she wrote resignedly: “We have known incurable cases discharged from one hospital, to which the deaths ought to have been accounted, and received into another hospital, to die there in a day or two after admission, thereby lowering the mortality rate of the first at the expense of the second.”
This Times Online article suggests adverse selection evidently isn’t anything new! This pretty much sums up the position in which children’s hospitals often find themselves. We accept transfers of very sick kids who sometimes die in our facilities. We get tagged with the mortality (or morbidity) while the transferring facility’s statistics artificially look good. Thought you would find this interesting.
1 comment so far | add a commentThree Must-Do’s for Children’s Hospital CEOs
December 6, 2009
Posted by chcablogadmin in : Healthcare Reform
Roch Parayre, Ph.D.
With health care reform looming large…
1) You need to be able to change quickly – to pivot quickly - to capitalize on things before others can. I recommend you have a bunch of little experiments on simmer so that as you see a new future emerging, you can pivot more quickly than you could without the experiments. A portfolio of experiments might include different care delivery models, different technology, different relationships – bottom line, this experimental mind-set will allow you to move quickly.
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