NEWS NEWS NEWS NEWS NEWS OFFICE OF THE GOVERNOR COMMONWEALTH OF PENNSYLVANIA Governor s Press Office Room 308, Main Capitol Building Harrisburg, PA 17120 www.governor.state.pa.us 717-783-1116 (Phone) 717-772-8462 (Fax) EDWARD G. RENDELL, Governor FOR IMMEDIATE RELEASE: July 20, 2007 CONTACT: Amy Kelchner, GOHCR 717-346-8379 GOVERNOR RENDELL SAYS NEW HEALTH CARE REFORM MEASURES COULD BE PRESCRIPTION FOR NATION INNOVATIVE REFORM MEASURES WILL IMPROVE ACCESS; QUALITY OF CARE PHILADELPHIA Governor Edward G. Rendell said the state today took its first steps in making health care more accessible and eliminating deadly hospital-acquired infections when he officially signed the first pieces of his Prescription for Pennsylvania health care reform plan into law. He also said people all over the United States could also benefit if states, or the federal government, follow the commonwealth s lead. Bills allowing advanced-practice nurses, physicians assistants and dental hygienists to practice to the full extent of their education and training, and a bill to more aggressively attack and eliminate hospital acquired infections were passed by the General Assembly. The Governor signed the bills during a ceremony at the University of Pennsylvania School of Nursing the same site where he initially announced the Prescription for Pennsylvania in January. The event was Web cast to a group of legislators and stakeholders at the VA Healthcare System, University Drive Division in Pittsburgh, another of the Governor s early stops on his Prescription for Pennsylvania bus tour. We started implementing our aggressive health care reform agenda in May with an executive order that established a program to better manage chronic diseases and address health equity issues. Today, we added initiatives so Pennsylvanians will have greater access to health care providers and they will be protected from deadly hospital-acquired infections, Governor Rendell said. These are the kinds of common sense programs that improve and save people s lives and save money. Governor Rendell s Prescription for Pennsylvania will increase access to affordable health care coverage for every uninsured Pennsylvania resident, improve the quality of care and control health care costs for businesses and employees. The Governor s plan will help to curb soaring health care costs that threaten continued economic expansion and needlessly cost taxpayers billions of dollars a year.
The first set of bills approved by the General Assembly will make it easier for patients to seek appropriate care where and when they need it. It will also help to reduce costs by enabling nurses, advanced training nurse practitioners, clinical nurse specialists, nurse midwives, physician assistants and dental hygienists to practice to the fullest extent of their training and skills. For example, Pennsylvania is currently the only state that does not allow nurse midwives to prescribe for their patients or allow advanced-practice nurses to order durable medical supplies like walkers and wheel chairs for bedridden patients. The bills signed today by Governor Rendell remedy that. Pennsylvania lags behind other states in fully using all licensed health care providers, and these initiatives will remove barriers that have kept them from practicing to the greatest extent allowed by their education and training, the Governor said. The second initiative focuses on improving patient safety and containing costs by eliminating hospital- and health-facility-acquired infections. The Governor noted that most hospital-acquired infections are avoidable. In Pennsylvania, however, the number of hospital infections reported last year was 19,154, which led to nearly 2,500 deaths and more than $3.5 billion in hospital charges. One example of a hospital- and health-facility-acquired infection specifically addressed in the Prescription for Pennsylvania is MRSA, a type of drug-resistant bacteria that is commonly carried inactive on the skin but can be deadly if it is introduced into the bloodstream. In 2004, there were 13,722 hospitalizations in Pennsylvania in which the patient had an MRSA infection a rate of 7.4 per every 1,000 inpatient hospitalizations. Data shows that 8.9 percent of those patients, or 1,221 people, died as a result of contracting MRSA. MRSA is almost exclusively contracted in a hospital setting, but can be virtually eliminated from health centers through simple patient-safety procedures. Groundbreaking work by Pennsylvania s veteran s administration hospitals has resulted in the near elimination of MRSA infections in those facilities. According to the Pennsylvania Health Care Cost Containment Council, or PHC4, the average charge of hospitalization in 2005 for a patient who became infected with a hospital-acquired infection was $185,260 and the average charge for a patient without an HAI was $31,389. The Governor said now that two large components of Prescription for Pennsylvania have been passed and a third on the improved management of chronic diseases is underway by executive order, he is looking forward to working with the legislature to enact the final pieces of his reform plan. To further expand access to care, the Governor said he will hold to his commitment to enact Cover All Pennsylvanians, or CAP, a program offering affordable basic health coverage to small businesses and the uninsured through the private insurance market. He said he will also push for passage of common sense insurance reforms that will make it illegal for insurers to use factors other than age, geographic location and family size when setting rates for small groups and individuals and making sure that a small group or individual paying the highest charge for a certain insurance product is paying no more than double those being charged the least. More information on Governor Rendell s visionary Prescription for Pennsylvania health care reform 2
plan may be found at www.rxforpa.com. ### The Rendell administration is committed to creating a first-rate public education system, protecting our most vulnerable citizens and continuing economic investment to support our communities and businesses. To find out more about Governor Rendell's initiatives and to sign up for his weekly newsletter, visit his Web site at: www.governor.state.pa.us. EDITOR S NOTE: Additional details of the measures signed by the Governor follow. Senate Bill 968 Erickson / DeLuca Health Care Acquired Infections Hospital-acquired infections (HAIs) are infections that patients contract while in the hospital. At the time of admission the infection was not present or developing. Most HAIs are preventable, yet over 2,478 Pennsylvanians die each year with HAIs. In 2005, Pennsylvania hospitals reported 19,154 cases of HAIs to the Pennsylvania Health Care Cost Containment Council, which resulted in hospital charges of $3.5 billion that year. (This is not the total number of HAIs for 2005, as hospitals were not required to report all HAIs until 2006.) In 2005, the average charge for a hospitalization for a patient who became infected with an HAI was $185,260 and the average charge for a patient without an HAI was $31,389. In 2005, the average payment for a hospitalization for a patient who became infected with an HAI was $53,915 and the average payment for a patient without an HAI was $8,311. Hospitals vary considerably in their ability to identify and report HAIs. By using electronic surveillance systems to identify infections, hospitals eliminate the potential for error in determining what is or is not an HAI. SB 968 focuses on surveillance and reporting to address both transparency and evidence based responsive infection control procedures. Pennsylvania is now the National leader on this issue as no other state has ever implemented a plan so comprehensive for the purpose of eliminating health care acquired infections. Health care facility referred to in the legislation includes hospitals and nursing homes; except in reference to Infection Control Plans which are to be completed by hospitals, nursing homes, and ambulatory surgical facilities. Infection Control Plans Facilities have 120 days to develop and implement an internal infection control plan after the effective date determined in SB 968. That infection control plan (ICP) will be completed according to the following requirements: The infection control plan must be developed by a multi-disciplinary committee including medical staff, administrative staff, laboratory personnel, nursing staff, pharmacy staff, physical plant personnel, a patient safety officer etc. 3
The ICP must include a system to identify and designate patients known to be colonized or infected with MRSA or other multi-drug resistant organism (MDRO) including: o Cultures and screenings of all nursing home residents admitted to a hospital o Identification and cultures and screenings of all high risk patients o Procedures for identification, cultures, screenings, and follow up care for staff who may have had exposure to a patient known to be colonized with an MDRO before that patient was identified An infection control intervention protocol based on nationally recognized, evidence based standards including isolation procedures, physical plant operations, use of antimicrobial agents, education programs for personnel, and fiscal and human resource requirements. Within 14 days of implementation of the ICP, a facility must submit the plan to the department of health for review for compliance with the required standards. When the plan is submitted the health care facility must notify everyone in the facility about the plan. Reporting Nursing homes will report infections based on the Centers for Disease Control definitions in accordance to what is determined by the department of health and the patient safety authority. Hospitals shall make reports within 180 days of enactment to the National Health Safety Network and the CDC. The reporting will be for all patients throughout the entire facility at all times. It will be conducted on a monthly basis and each hospital shall authorize the Department of Health, the Patient Safety Authority, and the Pennsylvania Health Care Cost Containment Council to access the data from the National Health Safety Network. If a hospital does not authorize the department, the authority, and the council to access the data from the NHSN, the hospital must continue reporting with PHC4 and the Patient Safety Authority. Electronic Surveillance Each hospital shall do an assessment by Dec. 31, 2007, to determine their ability and capacity to implement a qualified electronic surveillance by Dec. 31, 2008. If a hospital s assessment makes a positive determination they should begin implementing electronic surveillance prior to the Dec. 31, 2008, deadline. If a hospital s assessment shows they cannot implement a system by Dec. 31, 2008, then they shall continue using their current surveillance system until such time as they implement a system with assistance from the Department of Health. Quality Improvement Payments If by Jan. 1, 2009, a facility shows a 10 percent reduction in infections that facility will be eligible to receive a quality improvement payment. Every year after that the Department of Public Welfare 4
and the Department of Health determine potential payments based on a facility meeting benchmarks determined by DOH for each facility. If a facility implements a qualified electronic surveillance system, that facility is eligible for additional payments if they show reductions as determined by the department in reviewing benchmarks. No facility will receive a quality improvement payment if it is in violation of Health Care Facilities Act and payments will only be made dependent upon available funds. The Department of Health will act as a partner to health facilities in implementing the HAI plans in a variety of ways: Developing a public health awareness campaign about health care acquired infections and health care facility quality indicators. Reviewing and determining feasibility of using community organizations as a foundation for community based infection control outside of health care facilities. Reviewing infection control plans for compliance. Developing recommendations for infection control protocols and procedures for various incidents. Developing recommendations for screenings and cultures for MRSA and MDRO s. Reviewing assessments to determine feasibility of e-surveillance and assist in realizing that capacity in facilities Developing a methodology for analysis of NHSN data to compare a facility to itself over time, to similar facilities across the Commonwealth, and to other facilities across the nation to determine capacity, proficiency and effectiveness of ICP as well as to continually perform program analysis on best practice standards used in ICP s Using reporting data and comparative analysis to establish benchmarks which facilities must meet in reducing health care acquired infections. Nursing Homes Assessment Beginning on July 1, 2008, each nursing home shall commence reporting of infection rates and shall pay the department a surcharge on its licensing fee as necessary to provide sufficient revenue for the PSA to perform its responsibilities with regards to nursing home reporting. HB 1251 1255 and SB 455 Scope of Practice A significant percentage of adult and pediatric primary care can be provided by nurse practitioners and physician assistants and other non-physician health care practitioners, yet existing state laws and regulations preclude these health care providers from practicing to the fullest extent possible. HB 1251 and HB 1252 Representative Readshaw Physician s Assistants 5
Adding a physician assistant to a medical practice can virtually double the number of patients seen at a much lower cost for the service at the same level of quality. Past legislation limited the number of physician s assistants with whom a physician might establish a collaborative agreement to two. House bills 1251 and1252 expand that to four possible collaborative agreements. HB 1253 Representative Solobay Certified Registered Nurse Practitioners (CRNP) A CRNP while functioning in the expanded role as a professional nurse shall practice within the scope of practice of the particular clinical specialty area in which the nurse is certified. A CRNP may perform acts of medical diagnosis in collaboration with a physician and in accordance with regulations promulgated by the board. A certified registered nurse practitioner may now perform the following duties: Order home hospice care Order durable medical equipment. Issue oral orders to the extent permitted by the health care facilities by-laws, rules, regulations or administrative policies and guidelines. Make physical therapy and dietician referrals. Order respiratory or occupational therapy. Make respiratory and occupational therapy referrals. Perform Disability assessments for the program providing temporary assistance to needy families. Issue home bound schooling certifications Perform and sign the initial assessment of methadone treatment evaluations, provided that any order for methadone treatment shall be made only by a physician. HB 1254 Representative Gibbons Clinical Nurse Specialists The legislation defines the role of a clinical nurse specialist including educational standards and training requirements for various fields. Furthermore by establishing a clear legal definition of clinical nurse specialists, the legislation provides protection both the patients and nurses. In addition the legislation requires clinical nurse specialists to carry the appropriate level of medical liability insurance for whatever practices they are engaged in. HB 1255 Representative Waters Nurse Midwives Pennsylvania was the only state in the Nation which did not allow nurse midwives any prescriptive power. Approximately 10 percent of all babies born in the state are birthed by nurse midwives. In many areas of the Commonwealth these specialized nurse practitioners are also the only source of pre-natal and gynecological care. The legislation allows nurse midwives with proper pharmacologic training to write prescriptions within a collaborative agreement with a physician. SB 455 Senator Vance Dental Hygienists More than 1.5 million Pennsylvanians live in a federally designated dental health professional shortage area. In states with similar shortages, dental hygienists fill this void by providing routine dental care. Pennsylvania s licensing statute and regulations limit dental hygienists independence and the functions they can perform. 6
The legislation allows dental hygienists to perform specific functions without the direct supervision of a dentist in order to give them greater ability to provide basic dental hygiene services in a greater variety of settings. 7