Booneville Hospital Evacuates Patients Twice

Transcription

1 March 31, 2008 Volume 15, Number 13 Booneville Hospital Evacuates Patients Twice Booneville Community Hospital (BCH) became the second Arkansas Critical Access Hospital (CAH) in as many months to evacuate patients in response to a disaster following an explosion on the afternoon of March 23 at Cargill Meat Solutions, a local meat processing plant. In fact, BCH executed two evacuations over a two-day period. The initial move took place Easter Sunday after a welder performing routine maintenance in the plant accidentally started a fire that eventually caused several explosions. That resulted in the evacuation of 12 hospital inpatients, 10 of whom were transferred to Mercy Hospital of Scott County in Waldron. Two other patients were discharged to their homes. By Monday morning, the 10 patients who had been sent to the Waldron hospital were being cared for once more at BCH. However, that afternoon they were evacuated again due to a potential leak from an ammonia tank inside the burned-out plant. As of Tuesday, all patients returned to BCH. Hospital CEO Dzaidi Daud reported no issues related to the evacuation and transfer of the patients. Last month, patients at Stone County Medical Center in Mountain View, also a CAH, were evacuated after a February 5 tornado tore through the community causing substantial damage to the facility. Both occasions underscore the attention to detail that hospitals across the state have given in the development of their disaster response plans over the past few years and the paramount importance of conducting local and regional drills to employ those plans to ensure they work as they should, when needed. AHA Supports Wristband Safety Project At its March 14 th meeting, the Arkansas Hospital Association s (AHA) Board approved a statewide wristband standardization quality and patient safety initiative. Under this initiative, participating hospitals that use color-coded wristbands will agree to standardize the colors used. PURPLE wristbands will be used for DNR, RED for allergy and YELLOW for fall risk. The AHA will not advocate that hospitals start to use color-coded wristbands if they do not already use them, but those facilities that use wristbands will be encouraged to use the standard colors. The impetus for this type of project was an advisory issued by the Pennsylvania Patient Safety Authority, which arose out of a near miss report in which clinicians almost failed to resuscitate a patient who was incorrectly designated as a DNR because the nurse had unknowingly placed a yellow wristband on the patient. In that hospital, the color yellow signified DNR, but the nurse also worked at another hospital in which the color yellow signified restricted extremity not to be used for phlebotomy or IV access. A consortium of hospitals from Pennsylvania decided to join together to reduce the risks associated with the use of colored wristbands by standardizing the meaning of the colors, limiting the number of colors to avoid confusion, embossing the bands to reinforce the message conveyed, and removing or covering charity colored wristbands so that they are not misinterpreted as hospital alert bands. At least 20 state hospital associations have begun similar projects, including Paul Cunningham, Editor Phil E. Matthews, President/CEO; 419 Natural Resources Drive; Little Rock, Arkansas 72205; ; facsimile

2 AHA Notebook 2 March 31, 2008 Kansas and Missouri. Both Texas and Alabama are in the planning stages for their own wristband standardization initiatives. All states are using the same three colors, although a few states have added two more GREEN for latex allergy and PINK for restricted extremity. The AHA plans to develop toolkits, educational materials, seminars and other resources for its members and may work with a vendor that has sponsored initiatives of this type in other states. Medicare SNF Workshop Pinnacle Medicare Services, the state s Medicare fiscal Intermediary, will hold a Skilled Nursing Facility (SNF) General Update Workshop on Wednesday, April 30, Check-in begins at 8:00 a.m. and the training session is scheduled for 8:30 a.m. through 12:00 p.m. Participants will receive up-to-date information regarding recent changes in the Medicare Part A Program and gain an understanding of the impact these changes will have on SNF services, as well as guidance on appropriate actions to take in order to maintain compliance with Medicare policies and regulations. Topics include: CPT & HCPCS Updates Comprehensive Error Rate Testing (CERT) Update on SNF Edits Therapy Services Updates Therapy Documentation Requirements Medical Review Process UB04 Updates Recovery Audit Contractor (RAC) Updates National Provider Identifier (NPI) Medicare Administration Contractor (MAC) Updates The workshop, which is tailored for billers, Medicare managers, directors of rehabilitation, Minimum Data Set (MDS) coordinators, and medical and compliance personnel will be held in the Old Mill Conference Room at Pinnacle Medicare Services, 515 W. Pershing Blvd. in North Little Rock. There is no charge, but those who plan to attend should register to ensure space. Register online by going to New Rule Affects Hospice Billings A new Medicare rule that becomes effective on July 1 will affect the inpatient agreements which all hospice providers have with hospitals covering inpatient care for hospice patients with acute pain management or symptom control needs. The rule requires hospice providers to include in their monthly billings data that detail the services provided in the course of delivering each hospice level of care billed, including all medically necessary visits by hospital nurses, doctors and social workers with hospice patients in hospitals with which the hospice is contracting to provide the care. While Medicare has increased the billing requirements for most institutional providers over the past decade, hospice claims have remained relatively simple. Generally, hospice providers have been required to submit only a small number of service lines on Medicare claims to report the number of days at each of the four hospice levels of care. Healthcare Common Procedure Coding System (HCPCS) coding was required only to report procedures performed by the beneficiary s

3 AHA Notebook 3 March 31, 2008 attending physician, if that physician was employed by the hospice. The new rule is being implemented because Centers for Medicare & Medicaid Services now believes that this limited claims data has restricted Medicare s ability to ensure optimal payment accuracy in the hospice benefit and to carefully analyze the services provided in this growing benefit. To ensure compliance with the rule, hospice providers will need appropriate hospital staff to work with them in obtaining the necessary information. To learn more about the new rule, go to Senators Want Parity Compromise A bipartisan group of 25 senators are calling for a compromise with the House on mental health parity legislation this session. In a letter to Senate leaders, the group wrote, In sending this letter, we want to express our strong support for the intent of both these bills and let you know that we stand ready to work together to end the discrimination against people suffering from mental illness and addiction. The House recently approved H.R. 1424, legislation supported by the American Hospital Association (AHA) that would require group health plans offering mental health coverage to provide mental health and substance use disorder benefits on a par with medical coverage. That bill also would place a ban on the growth of physician-owned hospitals where a physician investor self-refers. That is a prohibition the AHA has long advocated. The Senate bill (S. 558), passed in September, provides for parity in financial and treatment limitations, but it does not include the self-referral ban. Heparin Product Recall B. Braun Medical Inc. (BBMI) issued a March 21 recall of 23 lots of heparin injectable products because the active ingredient may contain a contaminant. In announcing the recall, BBMI said the heparin sodium ingredient was supplied by Scientific Protein Laboratories. Braun said it had not received any related adverse event reports, but advised customers to stop using the products immediately and report any adverse reactions to the Food and Drug Administration s (FDA) MedWatch program. The FDA recently began investigating reports of serious injury or death in patients administered other heparin injectable products containing the contaminant. For details, see the company press release ( AHA, ARORA Co-Sponsoring CEO Webinar The Arkansas Hospital Association (AHA) and the Arkansas Regional Organ Recovery Agency (ARORA) are jointly sponsoring a free Webinar for hospital CEOs on organ donation. The program, Tools Your Hospital Can Use Tomorrow to Hardwire Organ Donation Results that Last, will be held from 1:00-2:00 p.m. on April 17, 2008 and will feature a discussion with Studer group coach Lynne Cunningham, a facilitator who has worked with hospitals, health systems and medical groups all over the country. With the intensified interest by The Joint Commission and Centers for Medicare & Medicaid Services in organ donation and transplantation, this is a Webinar series that CEOs can t afford to miss. To participate, call and enter the pass code The Web address is

4 AHA Notebook 4 March 31, 2008 Legal Note: HIPAA-Compliant Disclosures For Locating Suspects, Fugitives, Witnesses or Missing Persons The HIPAA Privacy Rule allows a hospital to disclose protected health information to assist law enforcement officials in identifying or locating a suspect, fugitive, material witness or missing person under 45 C.F.R (f)(2). In order to make this type of disclosure, a law enforcement official must have requested the information. A hospital cannot volunteer the information without a request, but the request may be verbal or written, or it may be broadcast through the media. Only the following limited information can be disclosed in response to this type of request: (a) the patient s name and address; (b) date and place of birth; (c) social security number; (d) ABO blood type and rh factor; (e) type of injury; (f) date and time of treatment and/or death; and (g) distinguishing physical characteristics, including height, weight, gender, race, hair and eye color, presence or absence of facial hair (beard or moustache), scars and tattoos. The hospital cannot disclose DNA or DNA analysis, dental records, or any other typing, samples or analysis of body fluids or tissue. HIPAA also requires that the information be disclosed only to a law enforcement official, which is defined as an officer or employee of a government agency or authority who has the legal authority to investigate potential violations of the law or to prosecute alleged violation in court or another proceeding. See 45 C.F.R HIPAA also allows a hospital to disclose protected health information to a law enforcement official if it believes that the information is evidence of criminal conduct that occurred on the hospital s premises. See 45 C.F.R (f)(5). No prior request from law enforcement is necessary for this type of disclosure. Although HIPAA allows these types of disclosures for law enforcement purposes, a hospital s policies and procedures may be more restrictive or require additional safeguards prior to disclosure. Accordingly, hospital personnel should follow applicable facility policies and procedures when divulging patient information for law enforcement or any other purpose. Suggested topics for the Legal Note may be submitted to elisawhite@arkhospitals.org. The Legal Note is provided solely for informational purpose and does not constitute legal advice. Readers are encouraged to consult with their own attorneys about any legal issues, including those discussed in this article. HCAHPS Patient Satisfaction Data Available The initial data set reflecting hospital patients experience of care is now available to consumers. The Hospital Quality Alliance posted the information taken from the Hospital Consumer Assessment of Health Plans Survey (HCAHPS) on the Hospital Compare Web site ( last Friday. Data from the patient survey provides a standardized look at hospital care in 10 areas, including communication with doctors and nurses, responsiveness of staff, communication about medication, pain management, discharge information, the hospital s quietness and cleanliness and the patient s willingness to recommend the hospital to others. This initial data was collected from patients at more than 2,500 hospitals and will be updated quarterly, with most of the nation s hospitals providing data by year-end. In addition to the HCAHPS data, the Centers for Medicare & Medicaid Services also moved to the Hospital Compare site its Medicare payment and volume data for a select group of patient diagnoses.

5 AHA Notebook 5 March 31, 2008 NewsNotes About Arkansas Folks Governor Mike Beebe has named James R. Jamie Carter, Jr., CEO of Crittenden Regional Hospital in West Memphis, to the Governor s Advisory Council on Trauma. His term expires July 1, Carter is a member of the Arkansas Hospital Association board of directors representing the Northeast Hospital District. Richard L. Goddard, FACHE, has resigned as CEO of Drew Memorial Hospital (DMH) in Monticello. Goddard, who represents the Southeast Hospital District on the Arkansas Hospital Association board of directors, has been at DMH for almost six years. A search for a permanent CEO is underway. Gary Looper has resigned as CEO of Northwest Health System (NHS) in Springdale. He is a member of the Arkansas Hospital Association board of directors representing the Northwest Hospital District. Looper said about his departure, It s with mixed emotions that I step down as CEO. Although there is personal joy in returning home to my Texas roots and family ties, there is also sadness as I leave behind a talented team. It has been a pleasure and privilege to lead Northwest Health System. Dan McKay, vice president of NHS s parent company Community Health Systems, will assume the role of interim CEO while a search is underway. Angela Richmond, administrator of Community Medical Center of Izard County in Calico Rock, also has been named administrator of Fulton County Hospital in Salem. Both hospitals will remain independent under Richmond s management. Both facilities are Critical Access Hospitals. The AHA Calendar April 2-4 Healthcare Financial Management Association (HFMA), Arlington Hotel, Hot Springs 3 EMTALA and the On Call Physician 2008: Ensuring Compliance Webinar #T Safety Series: Methodologies for Continuous Process Improvement, Safety and Risk Management: The Basics Part IV, Making the Leap from Lean Tools to Lean Culture for a Self-sustaining Performance Improvement Culture Webinar #T Improving the Revenue Cycle and Gaining Better Reimbursement Webinar #T The Patient Safety and Quality Improvement Act: The New Frontier in Patient Safety (A 2-Part Series) Part II: Specific Applications and Implementation Steps Webinar 9 High Stakes Communication Series 7-Part Audioconference Series Part 3: Medication Reconciliation 9 Critical Storage Monitoring Within a Hospital: Current Regulations and Requirements Webinar # Listening With Dignity and Respect Webinar #T Preparing for Medicare Recovery Audits Webinar #T AHA Mid-Management Certificate Series: Leaping from Staff to Management: You're a Manager... Now What?, Crowne Plaza, Little Rock 16 AHA Mid-Management Certificate Series: Leaping from Staff to Management: You're a Manager... the Next Steps, Crowne Plaza, Little Rock 16 How to Manage Your Mouth: And Other Strategic Communication Skills Webinar Editor's Note: Members of the Arkansas Hospital Association executive staff, along with 37 representatives from Arkansas hospitals, will be attending the American Hospital Association s Annual Membership Meeting in Washington, D.C. April 6-9. The Notebook will not be published on April 7. Publication will resume on April 14.

6 AHA Notebook 6 March 31, 2008 Final Thoughts by Paul Cunningham Later this week, hospital execs, managers and trustees from across the country, as well as representatives from practically every state hospital association, will begin loading into trains, planes and automobiles to make the yearly pilgrimage to Washington, D.C. for the American Hospital Association s (AHA) Annual Membership Meeting. The crew attending from Arkansas will start to gather on Saturday at the Hilton Washington Hotel, just north of Dupont Circle, the meeting s headquarters for, oh, the past hundred years, or so it seems. While there, they ll be able to network with friends and colleagues from other states about differing approaches to common problems and they will have the opportunity to hear an impressive panel of speakers detail some of the major challenges facing hospitals in the coming year. More likely than not, those private conversations and the public remarks will cover some common territory the possibility of Medicare/Medicaid reimbursement cuts, Recovery Audit Contractors (RACs), value-based purchasing, and patient care quality and safety. Everyone is sure to come away with some new insights, but they probably won t like much of what they hear in either setting. However, not liking what s said isn t necessarily a bad thing. It could add a touch more focus and drive to the real reason why the thousands of hospital types will be assembling in the nation s capitol: to make the case for reasonable policy decisions that will affect not only hospitals but also the communities they serve over the next five to ten years. In the end, everyone who convenes together at the AHA meeting will be on a mission to make sure that their House members and Senators fully understand the impact of actions taken on hospital matters in those chambers during the few actual legislative days remaining in this session of Congress. With that in mind, when the troops spread out across Capitol Hill on April 9 to visit with their state delegations, they ll be conveying common messages of equal importance to a large majority of America s hospitals. Briefly, they ll be pressing for Congress to: Guard against the president s proposed Medicare/Medicaid reductions by working with budget committee members in the House and the Senate to ensure that the final budget package protects funding for both programs; Support legislation (H.R.3533/H.R.5613/S.226) to extend for another year the moratorium on Centers for Medicare & Medicaid Services (CMS) rule to cut Medicaid spending administratively by, among other things, changing the way that intergovernmental transfers are allowed and used in lieu of state general revenues as Medicaid matching dollars; Support Medicare legislation this year that would (a) prevent physician payment cuts, (b) provide for cost-based outpatient lab services for rural hospitals of fewer than 50 beds, (c) maintain independent labs ability to continue billing Medicare directly for the technical component of certain physician pathology services provided to hospitals, (d) improve inpatient and outpatient payment for small rural hospitals, Medicare-dependent hospitals and sole community hospitals, including cost-based payment for those with 50 beds or fewer, and (e) ensure that Critical Access Hospitals which contract with Medicare Advantage plans are appropriately reimbursed; Support legislation containing provisions of Section 651 of the House s Children's Health and Medicare Protection (CHAMP) Act of 2007, which would effectively close the whole-hospital exception to the physician self-referral rule; and Support HR 4105, which provides additional time for improvements to be made in CMS new RAC program. There s one more thing that the group of 43 people from Arkansas will be emphasizing. A new bill, The Strengthening the Safety Net Act of 2008, is scheduled for introduction on April 8. It would add to the Medicaid Disproportionate Share (DSH) funding of 19 Low-DSH states, including Arkansas. If approved, it could help all the states hospitals. We ll make sure that all the Arkansas lawmakers recognize how important it could be.