CMS Provider Charge Comparison Data

Working your way through the large CMS Provider Charge Data file will take a bit of time and effort, but it’s certainly a gold-mine of comparitive costs.  Charges for the top 100 DRGs with and without major complications / comorbid conditions, is searchable across locations and organizations.  Downloadable as an Excel or comma delimited file.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

Hospital Inspections Site Launched

Healthcare transparency took a step forward this week.  The Association of Health Care Journalists (AHCJ) and the Centers for Medicare and Medicaid Services (CMS) have collaborated to bring HospitalInspections.org  online.

The searchable database contains information about serious federal safety rule violations in U.S. hospitals since January, 2011.  It does not contain hospital responses to deficiencies cited during inspections. Those can be obtained by filing a request with a hospital or the U.S. Centers for Medicare and Medicaid Services (CMS).

Searching is free.

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Example:  Greivance

One example documents a lengthy trail of CMS interviews with hospital personnel related to a patient’s complaint regarding a grievance letter to which she had received no response..

“An interview was conducted with S2 Divisional Director, Regulatory Management on 9/19/12 at 9:05 a.m. She reported the hospital was unable to locate what happened to the grievance letter after it was signed for on the loading dock.  Also the hospital has been unable to locate the letter sent by regular mail by the mother of Patient #7.

Review of the policy titled Patient Rights, Complaint, and Grievance Process, policy reference # OrgClin/020, revealed in part,  ” …All expressed concerns regarding care or treatment are entered into the approved complaint tracking software program …”

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Example:  Environment of Care / Fire Safety

“The inspector observed, while accompanied by the Plant Manager during the hours of the inspection from 8:00 am to 9:45 am on 7/24/2012 that the fire doors going into the generator room had the closers removed and the doors were propped open. The doors must be self-closing. If the facility requires the doors to be open, they must be placed on hold opens that will release with activation of the fire alarm.”

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The site also has a list of states that post their hospital inspections online.

Cost of an MRI? It Depends…

Walk into your favorite salon or spa and ask what a facial, a haircut, etc. cost and someone will quickly produce that information for you.

Walk into your favorite hospital or doctor’s office and ask what an MRI, a CBC, etc. cost and someone will quickly put you on hold or transfer you to another department.  After considerable time you’ll probably be told that “it depends.”

NBC News recently reported on this issue.  Martha Bebinger attempted to be a savvy healthcare consumer by shopping around for the cost of an MRI.  After much persistence and many phone calls, she got responses that ranged from $600.00 to $5,300.00.  After the scan she received a bill for $7,468.00.  Since she is insured, all she was required to pay was $25.00.  That bill, by the way, did not include the fees charged by the radiologist to interpret the test.

How about a simple lab test – a complete blood count (CBC)?  A web site called Clear Health Costs attempts to collect cost information on various tests.  According to the site a self-pay CBC in the New York area ranges from $16.00 to $117.00 depending on location.  There is also a disclaimer that reminds visitors that if they have health insurance the charges may be considerably different.

Ms. Bebinger’s advice?  “If you really have to pay attention to price because you have a high-deductible or a tiered coverage plan, then do a lot of deep breathing. Be ready for a long journey that will take some patience.”

Another bit of advice – share with your doctor that medical costs are of concern to you.  Sometimes an effective, less costly, “Plan B” can be developed that doesn’t involve so many expensive tests.

 

Respectful Management of Serious Clinical Adverse Events – an IHI Perspective

You just heard at this morning’s CEO leadership meeting that a 40-year-old father of five children died in the Surgical ICU last night, hours after receiving medication intended for another patient. Everyone is upset. Questions are flying around the hospital: What does the family know? Who did it? What happened? What can we say? Would the patient have died anyway? (He was very sick.) Has anyone gone to the press?

Every day, clinical adverse events occur within our health care system, causing physical and psychological harm to one or more patients, their families, staff (including medical staff ), the community, and the organization. In the crisis that often emerges, what differentiates organizations, positively or negatively, is their culture of safety; the role of the board of trustees and executive leadership; advanced planning for such an event; the balanced prioritization of the needs of the patient, family, staff, and organization; and how actions immediately and over time bring empathy, support, resolution, learning, and improvement. The risks of not responding to these adverse events in a timely and effective manner are significant, and include loss of trust, absence of healing, no learning and improvement, the sending of mixed messages about what is really important to the organization, increased likelihood of regulatory action or lawsuits, and challenges by the media.

So opens Respectful Management of Serious Clincal Adverse Events, an Institute for Healthcare Improvement Series White Paper.

Read the rest from IHI.

Source:  Conway J, Federico F, Stewart K, Campbell M. Respectful Management of Serious Clinical Adverse Events.
IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2010.

Patient Experience and Patient Grievance Process Linked

Patient experience, and thus patient satisfaction scores, are intrinsically linked with how a hospital or other healthcare organization handles its patient complaint and grievance process. 

In addiiton to making good business sense, there are specific CMS regulations and Joint Commission standards that outline how hospitals and ambulatory surgery centers must manage patient grievances. 

Lisa Venn, JD, MA, CHC, writes in Improving Patient Experience – A Critical Look at the Patient Grievance Process “Dissatisfied patients take their business elsewhere and in this era of decreasing revenue, increasing competition and heightened patient expectations, no hospital can afford to lose business.  Dissatisfied patient may also complain to regulators, accreditors, and/or sue, creating additional financial and reputational risk to the organization.”

The Joint Commission web site reports that 15% of the Sentinel Events they investigate come to their attention through patient complaints.

 

Ms. Venn also provides a Power Point presentation, Establishing A Hospital Patient Grievance Process,  which outlines the steps hospitals must take in order to create or refine their patient grievance structure in accordance with CMS regulations.

For organizations seeking better ways to track and report patient grievances, Simple Data Solutions offers an affordable Patient Comment & Grieivance Tracking Database.

CMS to Expand Hospital Compare in 2011

CMS plans to add new patient safety measures in the areas of hospital acquired conditions and healthcare associated infections, to the Hospital Compare Web site in 2011.

CMS also intends to begin utilizing displays of composite measures summarizing both process and outcome measures. This information collection request covers consumer research on displays, labels, and explanatory language to insure that the Web site is understood by viewers in a manner consistent with CMS’s intended communication message.

Federal Register, November 19, 2010

Mission Hospital, It’s Time To Say You’re Sorry

You may know the story of Taylee Blischke, a newborn who nearly died in April 2009 at Mission Hospital in Mission Viejo, California. Morphine was mistakenly given to Taylee, instead of her mother who was holding the infant. California investigators say mother and baby had IVs that were mixed up.  To add insult to injury, the hospital initially accused the baby’s mother Jessica of being a drug addict and passing the morphine along to her baby through her breast milk. 

Fortunately, Taylee survived and now appears to be a healthy toddler. 

In May, the California Department of Public Health fined Mission $50,000 for the error.

What bothers me most about this story is not the mistake, or even the initial accusation, it’s the official, carefully worded response that was recently issued by the hospital:

Our healthcare organization is deeply concerned about an incident that occurred in which an infant was mistakenly administered a medication last year. Consistent with our commitment to our patients we have conducted a process review and provided ongoing education and training for our patient care teams with regard to administering medications. While this incident is regretful, we are thankful that both the mother and baby were discharged in healthy condition …”

“While the incident is regretful?”  Now that’s a statement that exudes compassion and sincerity.

What is so difficult about saying ‘We are so sorry that Taylee was injured while under our care.”  It’s what Todd and Jessica Blischke deserve to hear.

More: Newborn Medical Mixup

9/2/10 Addendum: 

This case has, understandably, sparked a strong emotional response from many readers.  My purpose in including it here was not to blame or shame anyone.  I know that in nearly every case of serious medical error, caregivers are distraught.

My purpose was to draw attention to how fearful many  organization leaders remain to simply saying “We’re sorry,” when a sincere apology could do everyone so much good.  Sadly, it seems to be a challenge for most of us to say those words when they are called for.    ~Rita~