Fines & Sanctions

18 State Hospitals Penalized For High Infection Rates

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Eighteen Connecticut hospitals will lose 1 percent of their Medicare payments in 2016 as a penalty for comparatively high rates of avoidable infections and other complications, such as pressure sores and post-operative blood clots, according to new federal data. The Centers for Medicare & Medicaid Services (CMS) announced this month that 758 of the nation’s hospitals – about 23 percent of all eligible hospitals — would be penalized for patient safety lapses in the second year of the Hospital-Acquired Condition Reduction Program, which was mandated by federal health care reform. The penalties are based on rates of infections and other complications that occurred in hospitals between 2012 and 2014. The 18 hospitals in Connecticut include larger urban institutions, such as Yale-New Haven, Hartford and Bridgeport hospitals, and smaller hospitals, such as Manchester Memorial and Windham. They are among hospitals in the worst performing quartile nationally on patient-safety measures including the frequency of central-line and catheter-related infections, post-operative sepsis and accidental laceration.

I-Team In-Depth

Hospital Reports Of Surgical, Medication Errors Climb

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Connecticut hospitals reported record numbers of patients killed or seriously injured by hospital errors in 2013, with large increases in the numbers of falls, medication mistakes and perforations during surgical procedures, a new state report shows. The report, covering 2013, marks the first time that the number of so-called “adverse events” in hospitals and other health care facilities has topped 500 – double the number in 2012, when 244 such incidents were reported. Much of the increase was due to an expansion of reporting on pressure ulcers, which added a new category with 233 “unstageable” ulcers that were not counted before. Even without that category, however, reports of adverse events climbed 20 percent over 2012. The most significant increases were in the numbers of patients harmed by foreign objects left in their bodies after procedures – doubling from 12 to 25 in one year — or those harmed by perforations during surgical procedures – 79, compared to 55 the previous year.

I-Team In-Depth

Operating Profits Drop At State Hospitals: New Report

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Connecticut’s acute-care hospitals saw gains from their operations tumble 35 percent in the last fiscal year, with seven of 29 hospitals reporting operating losses, according to a new state report. While hospitals still ended the year with $597 million in profits overall, the report by the state Office of Health Care Access (OHCA) raises concerns that non-operating revenue, such as income from investments, was masking the decline in operating revenue. “While hospitals’ operational financial performance weakened in FY 2013, they continued to generate significant non-operating gains, helping to keep overall hospital financial performance strong,” the report says. “However, a robust financial picture should rely more on patient and other operating revenues, and not on a less than reliable income source, such as investment performance.”

Hospitals’ profits from operations dropped to $333.6 million, from $513.5 million in the 2012 fiscal year. At the same time, hospitals earned $70 million more from investments, charitable contributions and other sources of revenue.

I-Team In-Depth

Early Pregnancy Blood Test Reducing Need For Amniocentesis

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A simple blood test is transforming the world of prenatal screening, offering women a risk-free way to learn about fetal abnormalities early in pregnancy. Already, the new test has drastically reduced the demand for amniocentesis, an invasive procedure that diagnoses chromosomal disorders in mid-pregnancy and occasionally causes miscarriage. The blood test, which became available in late 2011, can analyze DNA to predict Down Syndrome and a few other genetic diseases as early as nine weeks in pregnancy, says Dr. Daniel Gottschall, medical director of Women’s Health Connecticut, a group practice with 80 offices around the state. “It’s almost like science fiction to see how they can do this with such a high level of accuracy,” says Leslie Ciarleglio, a genetics counselor at Hartford Hospital, where the number of amniocentesis procedures plummeted by more than 70 percent in just two years — from 112 in 2011 to 32 in 2013.   “It’s far more accurate than any screening test we’ve had before.”

The test, which experts consider one of the most important clinical tools to emerge so far from the genomics revolution, can alleviate fear and suffering for pregnant women worried about birth defects.   But the medical advance also raises disturbing questions about the future of screening — and whether the quest for the perfect baby could go too far. Currently, most women who get the blood tests are carrying high-risk pregnancies.

I-Team In-Depth

State Restrains Psychiatric Patients At High Rate

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As the state works to improve its mental health system, new federal data show that hospitals in Connecticut restrain psychiatric patients at more than double the average national rate, with elderly patients facing restraint at a rate seven times the national average. In addition, the state lags behind in providing adequate post-discharge continuing care plans for psychiatric patients, especially teens and the elderly. Connecticut’s 28 inpatient psychiatric units and hospitals developed continuing-care plans for fewer than 70 percent of patients they discharged from October 2012 to March 2013 – indicating that thousands of patients may have left facilities without adequate treatment and medication plans. A C-HIT analysis of the federal data, released by the Centers for Medicare & Medicaid Services for the first time, show that Connecticut ranks in the top fourth of states (11th highest) in the use of physical restraints in inpatient psychiatric facilities – and is the third highest state in restraining patients 65 and older. Two psychiatric units – at Bridgeport Hospital and Masonicare Health Center in Wallingford – have the 10th and 12th highest rates of restraint use, respectively, among the 1,753 psychiatric facilities nationwide that are included in the federal reports, which cover October 2012 through March 2013.

Disparities

Undocumented Immigrants To Strain Safety-Net Hospitals

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Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting new financial pressures on safety-net hospitals that provide emergency care to everyone, state and national health experts predict. The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means illegal residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care. “This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives.

I-Team In-Depth

Middle-Age “Senior Moments’’ Just Part Of Aging

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Everyone occasionally struggles to remember a name, blanks out on an appointment or forgets why they walked into the other room. But somewhere around age 40, those “senior moments” start to take on a new seriousness. They suddenly seem like scary signs of aging, perhaps harbingers of major memory loss to come. “A few years ago, these complaints were just dismissed,” says Dr. Anne Louise Oaklander, a neurologist at Massachusetts General Hospital in Boston. Now, researchers have become interested in mid-life memory, both to understand their patients’ complaints, and because of the recognition that the seeds of dementia are laid around this time of life.

I-Team In-Depth

Long ER Waits: Half Of CT Hospitals Over National Average Of 28 Minutes

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In more than half of Connecticut’s emergency rooms, the waiting time to see a health-care provider exceeds the national average of 28 minutes – a problem that experts say could get worse, as thousands more residents obtain health insurance. The average wait can stretch to an hour or more at Rockville General, Manchester Memorial, Bridgeport, Waterbury and Hartford hospitals, according to a C-HIT review of federal data. The statewide average waiting time is 30 minutes. The longest wait time is at Hartford Hospital, where patients were not seen for 82 minutes, on average; the shortest wait of 14 minutes is at Windham Hospital, the data compiled by the Centers for Medicare & Medicaid Services (CMS) through 2012 show. Officials at Hartford and Bridgeport hospitals claim shorter wait times than the federal data.

Women's Health

CT Breast Density Screening Law May Set National Standard

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Nancy Cappello wants all women to receive the same opportunities for breast cancer screening that women in Connecticut have had for years. Cappello, who worked for passage of the state’s 2009 breast density notification law, has taken her cause nationally – advocating for similar legislation in every state and lobbying policymakers in Washington D.C.

Connecticut’s law — the first of its kind in the country — requires radiologists to inform women who undergo mammography if they are diagnosed with dense breast tissue, a condition known to obscure cancer detection. These “inform” reports must reference potential benefits of supplemental screening such as an MRI or ultrasound. So far, 11 states have followed Connecticut’s lead by passing similar laws. According to data collected in Connecticut, ultrasounds have detected breast cancers that mammograms missed.

I-Team In-Depth

Hospitals Mobilize To Tackle Alarm Fatigue

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At Bridgeport Hospital, “talking bed rails” programmed to speak to patients in the geriatric psychiatric unit are helping to reduce the number of alarms that sound when a patient at risk for falling tries to get out of bed. At the Hospital of Central Connecticut in New Britain, health care professionals are adopting techniques from aviation safety experts to reduce the chances of a catastrophic event happening before a clinical alarm goes off. These are among the many ways Connecticut hospitals are tackling a phenomenon known industry-wide as alarm fatigue. Health care experts worry that medical devices with built-in alarms – such as heart monitors, infusion pumps and ventilators – designed to alert caregivers that patients are in danger could potentially put patients at risk because caregivers are desensitized by the sheer number of alerts and false alarms and fail to respond in a timely fashion. Research shows alarms in intensive care units are accurate less than 10 percent of the time, and 90 percent are false alarms.

Solutions for combating alarm fatigue range from alarm integration technology that sends alerts to a caregiver’s telephone to the development of a new generation of “smart alarms,” including ones designed to monitor multiple vital signs.