6 keys to reduce patient falls in hospitals

Patient falls are still a significant problem in facilities, and any injuries sustained during a fall can jeopardize a patient’s recovery. With that in mind, The Joint Commission has released new guidelines designed to help hospitals get better at preventing falls.  

fall-risk-patientAccording to The Joint Commission’s report, hundreds of thousands of patients fall each year in hospitals, and close to half of them are injured in some way.

Every fall resulting in an injury adds about $ 14,000 to the cost of treating each patient and over six days to each hospital stay.

In an era where both the cost of care and patient outcomes are on the feds’ radar, preventing falls should be top priority for hospitals.

Fall-prevention guidelines

Although many fall-prevention programs focus on the elderly, age isn’t the only determining factor. Confusion and weakness caused by illness, medications and even certain diagnostic tests can increase fall risk.

Because so many different patients are at risk for falling, prevention can be challenging. But The Joint Commission has outlined six key steps facilities should follow to reduce the risk of falls:

  1. Raise awareness of the need to prevent patient falls. Many falls are caused by communication breakdowns about the importance of following safety procedures to help patients avoid falling. Hospital staff at every level should be aware of the steps they need to take to prevent patient falls, from clearly marking wet floors to fully assessing patients for signs of delirium or exhaustion. It’s also important to provide staff with the resources they need for fall prevention, including regular training and technology like bed alarms (even if they aren’t the be-all and end-all for stopping falls).
  2. Create a multi-department fall injury prevention team. The most effective fall prevention team is made up of doctors, nurses, IT staff, pharmacists, physical and occupational therapists, quality specialists and executives. They provide multiple opinions and areas of expertise, and paint a clearer picture of where a facility needs to focus its efforts.
  3. Use a standardized tool to identify fall risk factors. The Joint Commission recommends several established assessment tools, including the Morse Fall Scale and the Hendrich II Fall Risk Model. Modules based on each tool can be integrated into a hospital’s electronic health records (EHR) system. Along with the tool, the commission suggests that providers perform individual risk assessments on each patient, taking into account the person’s gender, age, level of physical function and cognitive status.
  4. Develop an individualized care plan based on each patient’s fall and injury risks. The care plan should include action steps to prevent falls based on the patient’s physical condition and the setting where care is being administered. Strategies should be directly targeted to issues identified during the patient’s initial assessment.
  5. Integrate best practices into individual and general fall prevention plans. Along with targeted interventions, all fall prevention programs should contain a standardized process for patient handoffs. This decreases the likelihood that problems contributing to falls aren’t addressed during shift changes. Patients should also receive information from their clinicians about their individual fall risks, and what they can do themselves to prevent injuries.
  6. Use patient falls as training opportunities. Rather than punishing hospital staff, The Joint Commission suggests a more forgiving post-fall management program that includes elements such as “post-fall huddles” where your fall-prevention team and other affected staff members come together to analyze the situation. Healthcare executives should promote transparent reporting of falls so they can be tracked for prevention purposes. And patients who fall should be reassessed as soon as possible to track changes in their condition and keep any injuries from escalating into major problems.

New report paves way for more cost scrutiny

Get ready for more scrutiny of your facility’s inpatient and outpatient hospital costs – and surprisingly, it’s not coming from Medicare this time around. 

100-dollar-bills-stethescope-flagA new report released by a healthcare nonprofit outlines some of the sharpest differences in the cost of care for privately insured patients in similar geographic areas and markets.

The Health Care Cost Institute (HCCI) has compiled its Healthy Marketplace Index Report. According to a press release, the report shows the cost of care in more than 40 healthcare markets in the country.

Some of the general “high price areas” for healthcare costs include Milwaukee and Philadelphia, while “low price areas” include New Orleans and Tuscon, AZ.

Each market has its own quirks, but HCCI noticed three significant trends:

  1. Pricing isn’t tied to level of healthcare use. A natural assumption is that in areas where healthcare costs are higher for patients, patients use fewer healthcare services. But that’s not always the case. Areas such as Denver and Palm Bay, FL, rank highly for both inpatient care price and use of inpatient care services.
  2. Prices aren’t consistent. Pricing variations weren’t consistent across different types of care, even in the same area. Areas with higher prices for inpatient care didn’t always have higher prices for outpatient care as well, and vice versa. Example: Miami had high prices for outpatient care, but low prices for inpatient care.
  3. There may be a relationship between inpatient services and general health. In areas with more patients using inpatient services, there were lower rates of premature death. Although this relationship wasn’t closely analyzed in the report, it’s worth noting for hospitals, especially as inpatient hospital stays draw more scrutiny from third-party payors.

Transparency & pricing

While pricing varies sharply, there are stark variations in how much patients pay out of pocket for common medical procedures – in some cases, there are differences of hundreds of dollars.

More states are demanding that hospitals be more transparent about the costs of the services they provide patients. And there’s also a demand for more consistency in pricing across all healthcare markets.

While Medicare’s exploring the use of bundled payments for certain services to offer some stricter price controls, other insurance plans are trying programs with “reference prices,” where they’ll only reimburse hospitals for a certain amount and leave the rest up to patients to pay.

And if these kinds of models take hold, patients will be clamoring for even more information – from both their insurance carriers and their hospitals – about how much services cost.

Some hospitals have already made steps to determine just how much their care costs. Data like what’s included in the HCCI report only puts more pressure on healthcare executives to justify why treatment costs at their facilities aren’t the same as the hospital down the road – or even in a neighboring state.

In this era of growing price transparency and scrutiny of expenses, it won’t be enough for hospitals to simply blame private payors for setting prices. They’ll be expected to answer detailed questions about their payment rates in comparison to other facilities. And they’ll also be fielding the same questions regarding uninsured patients.

Hospitals should start preparing for this increased scrutiny by reviewing their payor contracts and getting a clear handle on the general cost of healthcare services both in their immediate area and in other areas with similar demographics.

7 Myths of Healthcare Cloud Security Debunked

Even as cloud computing is increasingly adopted by healthcare organizations to host new workloads and applications, misconceptions still persist about the resilience and assuredness of cloud security. Most of these concerns are rooted in outdated or incorrect information, fear of change, and common myths. This whitepaper reveals the truth behind these myths to give you candid insights into the pros and cons of leveraging healthcare cloud technology to its fullest, safely and securely.

Learn more!  

Securing Health Data in a BYOD World

In many ways, Bring Your Own Device (BYOD) sounds good to healthcare leaders. It can improve productivity, optimize practitioners’ time and even reduce capital expenditures. But there’s a flip side to BYOD that often sends shudders down the spines of healthcare IT executives and hospital administrators: As BYOD usage increases, so can security vulnerabilities. Use this whitepaper to help your organization fully prepare for the risks and rewards of BYOD.

Learn more!  

Focus on this area to reduce readmission rates

healthcare-worker-with-patientReducing readmissions is a complex problem. And since there’s so much pressure on hospitals to lower them, finding a viable solution is top priority. New research shows taking one simple step can make a big difference. 

What’s the step?

Prioritizing better patient communication.

According to an article in Harvard Business Review, a research team looked at several years of data from thousands of different hospitals. The biggest factor affecting readmissions – How well doctors and clinical staff communicate with patients.

The study results, which were published in research journal Management Science, showed if a hospital prioritized better patient communication, it could reduce its readmissions rate by 5%.

Patient experience & care

Researchers came to this conclusion by examining results from the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS), the patient satisfaction surveys Medicare patients and their families fill out after hospital stays. Specifically, they examined the impact of two different measures:

  1. “Communication-focused” areas of the survey pinpointing how well clinicians are able to engage patients in meaningful conversations, and
  2. “Response-focused” areas corresponding with how well and how quickly clinical staff are able to respond to patients’ needs.

The results from the HCAHPS survey questions were compared to the quality of each hospital’s process of care and its performance with readmissions.

For further context, researchers looked at detailed case studies examining five acute care hospitals and their results.

Impact of communication

Although many hospitals spend the bulk of their focus on improving response times for patients’ needs, communication makes a bigger difference.

Researchers found that response times accounted for a less than 3% difference in readmission rates, compared to the 5% decrease caused by better communication.

Traditionally, communication skills aren’t stressed in medical education or continuing training. Clinical skills take top priority. But the positive impact of excellent communication makes sense. Patients who receive clear information from providers can be active partners in their recovery, which leads to better outcomes.

Even better news: It’ll cost facilities less money to improve the communication skills of clinical staff, than other investments such as state-of-the-art amenities – or even different types of training.

Researchers discovered in facilities with excellent care quality, the cost per patient discharged to boost communication is $ 48, while the cost per patient to improve response times is $ 62.

Starting point

For these reasons, it’s worthwhile for your hospital to explore ways to get doctors and other staff regular training on how to communicate better with patients – not only for lower readmission rates, but for higher patient satisfaction scores (which are also becoming more significant for reimbursement).

It’s particularly important for any future communication training to address the best ways for clinicians to talk to people who may have low health literacy or are intimidated by the treatment process in general. Improving communication for this group of patients is likely to reap significant positive results.

Why medical device security should be top priority

While it’s not common just yet, hacking medical devices is poised to be one of the most significant security threats your hospital will face in the near future. And facilities that don’t start protecting themselves now could experience big problems. 

man working on computerDespite what TV shows and movies might have you believe, the worst that can happen if a hospital medical device is hacked has nothing to do with patients’ health.

Dramatic scripted scenes can leave the impression that the goals of hackers are to make an insulin pump malfunction or a pacemaker stop working.

But most troublemakers aren’t looking to hurt patients physically – they’re trying an alternate method to get their hands on valuable protected health information (PHI).

Medical records are chock-full of sensitive data that can be sold for a hefty price on the black market. And because many hospital medical devices are unprotected, they’re an easy way for a tech-smart crook to gain indirect entry into a facility’s IT infrastructure – including an electronic health records (EHR) system.

Dangers of ‘medjacking’

This practice has been dubbed “medjacking” by cybersecurity experts, and it’s growing in popularity, according to an article in Healthcare IT News.

In fact, three different hospitals have recently fallen victim to medjacking attacks.

The first one involved a blood gas analyzer that cybercriminals infected with malware. The device was used to steal passwords to access other hospital systems.

With the second attack, hackers gained access to a hospital’s main network via its radiology department’s image storage system. A third hospital experienced a security breach when criminals exploited a weakness in a drug pump to break into its network.

Response to security issues

Attacks like these are usually caused by hackers exploiting known weaknesses in medical devices – issues recognized by both vendors and the government.

Despite this, however, fixes are slow from manufacturers. Both the Food and Drug Administration (FDA) and the Department of Homeland Security are putting more pressure on companies to address these vulnerabilities.

But for now, the pressure is on facilities, who are still responsible for most of the consequences if their systems are breached through medical devices.

Your hospital’s best bet: Only work with companies and vendors that offer strong security features on their medical devices, including data encryption.

Additionally, it’s important that your IT department is keeping track of any security risks related to medical devices that arise so you can create a risk assessment plan to safeguard the PHI saved in your EHR. Putting tight controls on exactly how much confidential data these devices can access is essential.

All the measures your facility is taking regarding medical device safety should be included in the hospital’s risk assessment plan. There should also be a section mentioning how your facility will react in case a medical device attack does occur, taking all the facility’s different devices into account.

Hospital system lands in hot water for referral practices

Your hospital must be careful with the payment agreements it makes with associated doctors and practices, especially regarding referrals. Reason: If these arrangements don’t comply with the law, hefty penalties could result. One hospital system just found that out the hard way. Scales of justice

Adventist Health System, which operates several hospitals in Florida, must pay $ 118.7 million as part of a settlement with the U.S. Department of Justice. The whistleblower lawsuit accused Adventist of offering doctors excessive compensation for referrals, according to an article in the Daytona Beach News Journal.

The suit, which was filed by three ex-employees, alleged that Adventist created a scheme where doctors were offered large salaries and other perks to refer their patients to Adventist hospitals.

Some of the perks included paying the leases for a surgeon’s two high-end cars, giving a family practitioner a base salary that was twice what other primary care providers in the area received, and paying a part-time dermatologist over $ 710,000 in a year.

Doctors who signed on to work for Adventist and received these benefits were allegedly required to refer patients to the health system’s hospitals, in violation of the Stark Law and the False Claims Act.

Along with these problems, the healthcare system was also accused of incorrectly billing services to Medicare.

Hospital’s response

As part of the settlement, Adventist Health System will pay almost $ 4 million to various states where it operated hospitals, including Florida, Texas and Tennessee. The rest will go directly to the feds.

Adventist admitted no wrongdoing, saying it did its own review and “voluntarily disclosed” information about its compensation strategy for doctors. It also released details about what it calls “highly technical billing and coding issues” that may have affected its claim submission process.

According to the health system, the issues it disclosed had no effect on the “quality, safety or individual cost of patient care at [Adventist Health System] hospitals or clinics,” per a statement it released about the lawsuit.

Review business arrangements

Your hospital may not have the same issues Adventist did with its salary practices or signing bonuses, but it’s still crucial to give any arrangements with primary care physicians a thorough inspection. More and more hospitals will be looking to partner with family practitioners as a larger focus is placed on maintaining the continuum of care.

Legally a hospital can’t offer doctors any incentives for referrals – even if they’re small. Patients can be given objective information about the services your hospital offers, but rewarding a doctor for marketing your facility to patients isn’t compliant with federal law.

With that in mind, any agreements your hospital makes with physicians must be free of any clauses that could raise eyebrows or lead to legal trouble.

When in doubt about a potential business arrangement, especially when consolidating or merging, err on the side of caution and consult with your hospital’s legal team before proceeding.

Hear ye, hear ye: ICD-10 is finally here

For years and years your facility has been preparing for this day, and it’s finally here! Sure, it’s been delayed a few times, but no more! Today is the day of reckoning – the absolute final ICD-10 deadline! 

453886289Of course your facility does have a little cushion: CMS will reimburse wrongly coded claims, as long as the incorrect code is in the same broad family as the correct code for one year after the deadline.

This is a nice bone to be thrown, since there are around 70,000 codes in ICD-10 as opposed to the 13,000 codes that were in ICD-9. Not to mention the fact that instead of being five characters long, the codes can be anywhere from three to seven characters long.

There’s been a lot of stress leading up to this day, and there will probably be even more. It’s said that hospitals and practices will experience a drop in revenue while everyone is getting up to speed coding with ICD-10.

But the greater specificity the ICD-10 codes offer when it comes to reporting diagnoses is supposed to smooth out the billing process (really?), as well as assist in population health and cost reduction across healthcare delivery systems.

Reduce stress

Another thing the greater specificity will do for you: Give you a good laugh.

That’s right!

There are some codes in ICD-10 that will make you go “Huh?” and make you laugh.

Here are some of the best ones:

  • V91.07XA – Burn due to water-skis on fire, initial encounter (This has to be one of my favorites, because don’t you just think how and why? Maybe, people were trying to get on that “Jackass” show or in one of the movies and were using water skis to ski down a street while they were on fire?)
  • V95.41XA – Spacecraft crash injuring occupant, initial encounter (Just an fyi, if it happens again V95.41XD is for a subsequent encounter!)
  • V97.33XA – Sucked into jet engine, initial encounter (Ouch! And as if being sucked into a jet engine the first time wasn’t bad enough, if it happens again, you have V97.33XD for a subsequent encounter. And yes, we know “subsequent encounter” means with a physician, not a jet engine, but where’s the humor in that?)
  • Y92.146 – Swimming-pool of prison as the place of occurrence of the external cause (I didn’t even know prisons had pools!)
  • W56.22XA – Struck by orca (Now you know this one had to be requested by people who work at SeaWorld.)
  • W56.32X – Struck by other marine mammal (Just in case it wasn’t an orca that struck you.)
  • Z62.1 – Parental overprotection (Can you say helicopter parents?)
  • Z63.1 – Problems in relationship with in-laws (So what’s new?)

So as you can see, ICD-10 will cover you for just about anything.

In fact, if it walks, swims, slithers or flies and it bites you, there’s a code for it. Don’t believe me. Just click here and search “bitten by”. You’ll find everything from a chicken to a squirrel to a sea lion to a pig to a parrot to a macaw, to a … You get the picture.

So hopefully you’ve been able to de-stress and laugh a little, because you know what they say – laughter is the best medicine!