The Affordable Care Act and Vascular Access

Posted on by Greg Dennis

How the ACA’s Pay-For-Performance Programs Target Catheter-Related Bloodstream Infections

body-veinsThe mainstream media has primarily covered the Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) for how it affects health insurance. But as healthcare insiders, readers of this blog know there’s much more to this groundbreaking piece of legislation — including its provisions aimed at upping healthcare quality and lowering healthcare costs. Many of those provisions affect the practice of vascular access because catheter-related bloodstream infections (CRBSIs) have both quality and cost implications.

Healthcare providers should be taking a close look at these sections of the law because they can affect everything from reimbursements to materials management. Vascular access specialists (VAS’s) should know the provisions, too, because the ACA targets vascular access outcomes.

Continue reading “The Affordable Care Act and Vascular Access” →

Study Shows Chlorhexidine-Impregnated PICC Eliminated Bloodstream Infections and Reduced Thrombosis

Posted on by Greg Dennis

Teleflex Good Shepherd fotoA study published in the Fall 2014 issue of the Journal of the Association for Vascular Access (JAVA) showed that a chlorhexidine-impregnated peripherally inserted central catheter (PICC) eliminated central line-associated bloodstream infections (CLABSIs) during the two-year study period (July 2011-July 2013). In addition, only one incidence of thrombosis occurred during the study period – a non-occlusive thrombus associated with device insertion. When the study ended, the good results continued: No CLABSIs or episodes of thrombosis were associated with the catheter between the end of the study and the study’s publication.

Continue reading “Study Shows Chlorhexidine-Impregnated PICC Eliminated Bloodstream Infections and Reduced Thrombosis” →

IV Catheter Is Found to Reduce Bloodstream Infections and Treatment Costs

Posted on by Greg Dennis
lorente
Dr. Leonardo Lorente

A recent study found that a central venous catheter (CVC) designed to reduce bloodstream infections totally eliminated them at a hospital in Spain. The antimicrobial CVC also sharply reduced treatment costs related to the infections, compared to the unprotected CVC matched against it. You can read a study summary here.

The antimicrobial CVC in the study was the ARROW® CVC with ARROWg+ard® Technology. The catheter achieves its antimicrobial effect from a protective layer of chlorhexidine and silver sulfadiazine bonded to the catheter’s surface.

Continue reading “IV Catheter Is Found to Reduce Bloodstream Infections and Treatment Costs” →

Expanding Scope of Practice for Vascular Access Specialists Can Improve Quality Care

Posted on by Greg Dennis

Part 2 of a two-part post.

Vascular_Access_Team_300pxThe Affordable Care Act (ACA), more commonly known as Obamacare, is 906 pages long. But amidst all that detail are a few driving goals. One of those is something few would argue with: higher quality healthcare at lower cost. That’s also the focus of a new white paper on vascular access.

It’s no wonder the ACA’s authors made that a priority. The U.S. lags behind other industrialized countries on both sides of the quality/cost equation. We have the most expensive healthcare, by far, among industrialized nations, according to both the Organization for Economic Co-operation and Development (OECD) and the healthcare-focused Commonwealth Fund. The U.S. also ranks worse than many of these nations on some measures of quality, including safety.

That brings us to Leslie Schultz, RN, Ph.D., Director of the Safety Institute at Premier, Inc., Continue reading “Expanding Scope of Practice for Vascular Access Specialists Can Improve Quality Care” →

How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties

Posted on by Greg Dennis
Leslie Schultz
Leslie Schultz

At the recent annual meeting of the Association for Vascular Access (AVA), speaker Leslie Schultz, Director of the Safety Institute at Premier, Inc., introduced a provocative idea. Vascular access professionals, she said, can help their employers avoid the substantial financial penalties they face for high rates of central-line-associated bloodstream infections (CLABSIs).

Schultz was referring to the substantial penalties mandated by the Affordable Care Act (ACA), popularly known as Obamacare. The ACA tries to improve healthcare and lower costs by penalizing hospitals that trail most of their peers in preventing infections.

Schultz has a keen sense of the contributions nurses can make to minimizing a hospital’s CRBSI rate. In addition to her role at Premier, she is an RN as well as a Ph.D. Premier’s Safety Institute offers free information, tools, and resources to advance patient safety.

Before diving into how vascular access professionals can leverage their expertise to reduce CRBSIs and the associated penalties, here’s some crucial background. Continue reading “How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties” →

ASCO Meeting Features First Independent Comparison of Breast Cancer Genomic Tests

Posted on by Greg Dennis

The combined MammaPrint and BluePrint genomic tests provide more information about the specifics of breast cancer than does the older, 21-gene test, according to the first independent assessment comparing the assays. That study was among the major new findings about breast cancer molecular diagnostics – also called genomic tests – emerging from this year’s recent annual meeting of the American Society of Clinical Oncology (ASCO).

Brufsky for DD blogAlso featured at ASCO were new insights about breast cancer in African-American women, drawn from research with MammaPrint and BluePrint conducted in the nation’s capital.

Together, the 70-gene MammaPrint and 80-gene BluePrint tests definitively categorize patients as Low Risk or High Risk for breast cancer recurrence and provide additional information about the specific biology of the cancer. The older and less sophisticated 21-gene test, on the other hand, stratifies patients into three risk-recurrence categories: Low Risk, High Risk, and Intermediate. Continue reading “ASCO Meeting Features First Independent Comparison of Breast Cancer Genomic Tests” →

Does Infection Reporting Really Work? We Don’t Know Yet

Posted on by Greg Dennis

We are now about ten years into the phenomenon of states’ requiring acute care hospitals to report healthcare-acquired infections (HAIs) to their departments of health. At this point, most U.S. states and territories have enacted such laws.

An article in the June 20 issue of the American Journal of Medical QuaInfection reporting imagelity describes trends about enactment of the laws themselves and the type of data the laws cover. An abstract of the article can be found here.

Highlights from the authors’ research:

*As of January 31, 2013, the total number of states and territories adopting mandatory reporting laws had reached 37 (71%). Most of these laws were enacted and became effective in 2006-2007.

*Nearly all states (92%) that have HAI reporting laws mandate that data on central line-associated bloodstream infections (CLABSIs) in adult intensive care units be submitted to the appropriate state agency.

*About half of states (54%) require that methicillin-resistant Staphylococcus aureus infections be reported. A similar number (51%) require reporting of Clostridium difficile infections.

Substantial resources have been committed to the reporting effort, both at the facility and state levels. That’s why the authors suggest that future research should focus on whether these laws have been effective in reducing HAIs, which is their intended result.

Consumers Union has long campaigned for patient safety improvements in U.S. healthcare, including the mandatory reporting of infections. You can stay abreast of their and other efforts in this regard here.

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Survey Says Infection Prevention Is Improving, but Hand Hygiene Remains a Big Challenge

Posted on by Greg Dennis

Hand hygiene is the most challenging area of compliance in infection prevention, according to results of a survey conducted by Infection Control Today (ICT). Half of infection preventionists who responded to the survey identified hand hygiene as the biggest issue.

The ICT survey uncovered an apparent increase in compliance with best practices and methods among various institutions. Among respondents, 69% said they believe their institutions have increased compliance with infection prevention in the last five years. And 56% say they are spending more time boosting healthcare workers’ compliance.

Most respondents said they feel that their institution supports a culture of safety and accountability, and that they believe their faculty supports them in their efforts to prevent infection. Opinions are mixed, however, on whether an incentivized or punitive approach affects compliance.

Overall, this ICT survey shows a positive trend in infection compliance. While cost pressures will certainly impinge upon infection-prevention efforts, factors supporting more infection prevention include financial incentives within the Affordable Care Act, as well as the expanding adoption of improved infection-prevention technology.

Review the slide show for yourself on ICT’s website.

CDC Issues New Healthcare Infection Data for 2011

Posted on by Greg Dennis

Courtesy of Becker’s Infection Control & Clinical Quality, here are 17 points from the CDC’s “Multistate Point-Prevalence Survey of Health Care-Associated Infections” for 2011.

1. In 2011, 4 percent of inpatients at acute-care hospitals had at least one HAI, totaling approximately 648,000 patients with 721,800 infections.

2. One in 25 patients will contract at least one infection during a hospital stay.

3. Approximately 75,000 patients with HAIs died during hospitalization.

4. Pneumonia and surgical site infections were the most common HAIs, each accounting for 21.8 percent of all infections.

5. Gastrointestinal infections accounted for 17.1 percent of all HAIs.

6. Urinary tract infections totaled 12.9 percent of all infections.

7. Primary bloodstream infections totaled 9.9 percent of all infections.

8. Approximately a quarter of all HAIs, 25.6 percent, were associated with medical devices, such as catheter-associated urinary tract infection, ventilator-associated pneumonia and central-catheter associated blood stream infection.

9. Approximately 43 percent of non-surgical site infections developed within 48 hours of a stay in the critical care unit.

10. Colon surgeries experienced the highest number of SSIs, at 14.5 percent, followed by hip arthroplasties (10 percent) and small bowel surgeries (6.4 percent).

11. The median interval from hospital admission to HAI symptoms was six days.

12. One in five HAIs was present on admission and was related to a previous admission to the same hospital.

13. The most common pathogen was Clostridium difficile, accounting for 12.1 percent of infections.

14. The majority of gastrointestinal infections, 70.9 percent, were due to C. diff.

15. Staphylococcus aureus accounted for 10.7 percent of infections.

16. Klebsiella pneumoniae and K. oxytoca accounted for 9.9 percent of infections.

17. Escherichia coli accounted for 9.3 percent of infections.

What Does Healthcare Transformation Mean for Risk Managers?

Posted on by Greg Dennis

Susan Carr, editor of Patient Safety & Quality Healthcare, does a good job on the PSQH blog of beginning to answer questions about healthcare risk managers and the transformation of care. Carr discusses comments by futurist Ian Morrison at the annual conference of the American Society for Healthcare Risk Management.

Morrison says the Affordable Care Act isn’t the only factor shaping the changing world of healthcare risk managers. Other influences —consolidation, cost reduction, and realignment of risk—are also crucial.

Morrison’s key issues as outlined in Carr’s article:

1. ) Implementation of the Affordable Care Act and expansion of healthcare coverage to previously uninsured individuals. We may be heading toward two Americas, represented by Texas and California. The difference? The first is one of about half of the states that have refused to expand Medicaid. California, in comparision, has embraced the ACA and expanded Medicaid.

2.) Growth of the individual consumer market in which people have to make many more choices about details of their health insurance: “Morrison believes that individuals’ awareness of the narrow provider networks that come with ‘cheap’ plans is a ‘shoe still to drop.’ “

3.) Realignment of risk. Morrison foresees a country of “100 to 200 large regional systems of care across the country that assume risk on a population basis.”

4.) The changing business model for hospitals and health systems. That means more price pressure, along with an emphasis on value-based purchasing. “Morrison believes this shift ultimately means that hospitals will go from being in the business of filling beds to the business of emptying beds” – while trying to remain financially viable.

5.) Implementing and sustaining a culture of low risk and high quality is critical, and we’re not there yet. It will, he said “make the difference between life and death, between affordability or not.”

More from Carr’s article here.