I am not sure I totally agree with this methodology, but I can certainly add that in my travels, the "old school" hospital administrators do exist and I have experienced this first hand myself, even with walking in with a "Tablet PC".  In today's world of evolving medical technology, I would think that administrators would at least 'look" at new developments and embrace at least some of the more simple techniques in their own daily use as this really helps IT administrators with bringing new technology to table. 

Many IT managers rely on someone above their position to create budgets for this and if the folks at the top don't have at least an interest, many good and relatively inexpensive solutions are tabled with some of the reasons listed below.  By far, one of the most common responses I have heard is "we can't afford it", and that sometimes stated even before even exploring new avenues and closes the door immediately to new technology.  Perhaps as CMS expands their requirements, the "old school" administrators may someday take another view on what technology can do to save lives.  Even "baby steps" in the right direction can prove beneficial and sometimes are not that expensive to deploy.  On the flip side of the coin, there are the innovative hospitals that are taking big strides in this direction as well, taking time to share the knowledge with physicians on staff to ensure everyone is on the same team.  Sharing knowledge today is one of the biggest tools we have to benefit all.  BD

The proposed deadline is October 2008, so there's time left before new guidelines appear and perhaps some of the "Old School" administrators may have time to wake up to entertain revenue growth and place less emphasis on cost reduction to bring some real win-win solutions to the table for all and help saves lives at the same time.  One of the best ways for an "old school" administrator to benefit is to begin adapting new technology in their personal lives, as this brings a whole new understanding to the table with familiarity and use. 


Overall patient safety in hospitals is not improving. The latest HealthGrades report on patient safety in U.S. hospitals showed the PSI (AHRQ's patient safety index) rate increased 8% between 2003 and 2005 (more here). The lack of significant progress with patient safety has caused some to ask why payors reimburse hospitals for the additional care necessary after a patient suffers a preventable adverse event. It seems payors are starting to ask themselves this very question - according to this Indianapolis Star story:

Late next year Medicare plans to stop paying hospitals for costs incurred from some of the most common and preventable medical errors suffered by patients.

The federal Centers for Medicare and Medicaid Services, which operates Medicare, is taking public comment on the proposal through June. The changes are scheduled to take effect in October 2008.

Medical mistakes are deadly and expensive. Infections acquired in hospitals account for about 90,000 deaths and $4.5 billion in extra spending each year, according to the U.S. Centers for Disease Control and Prevention.

Unfortunately, most hospital administrators are more focused on cost reduction than revenue growth, and (if recent reports on patient safety "improvements" are to be believed) the stick - reduced reimbursement - will probably offer an incentive than the carrot.
CMS is starting with a subset of the list. Here are the 13 "never should happen" adverse events that CMS is considering for no reimbursement:

  1. Catheter-associated urinary tract infections
  2. Bed sores
  3. Objects left in after surgery
  4. Air embolism, or bubbles, in bloodstream from injection
  5. Patients given incompatible blood type
  6. Bloodstream staph infection
  7. Ventilator-associated pneumonia
  8. Vascular-catheter-associated infection
  9. Clostridium difficile-associated disease (gastrointestinal infections)
  10. Drug-resistant staph infection
  11. Surgical site infections
  12. Wrong surgery
  13. Falls

Starting to withhold payment for adverse events will impact the health care industry as much as DRGs and capitation did years ago. Many "old school" hospital administration management techniques will fall from favor because doing things like increasing nurse to patient ratios have been repeatedly shown to result in more adverse events. This change will also eliminate the need to regulate nurse to patient ratios, like they have in California and a few other states - hospitals that operate at unsafe ratios this will go out of business (as they should).
Every hospital wants to make improvements that are easy and cost next to nothing. One of the frustrations of being a consultant is doing the needs assessment, the cost justification, and the implementation plan only to hear that, "that's really too much trouble - we don't want to do it." Of course it's even worse if you're employed by the hospital (or vendor) as part of a LEAN team or innovation workgroup.

Source: Medical Connectivity Consulting


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