Hint: them

Recently, US News & World Report released its “Best Hospitals” list.  What’s interesting is what criteria a national news magazine uses to judge what’s “best.”  Link here.  

The criteria seems to favor reputation versus results.  Note that patient safety only counts five percent toward the total score and ranking.  Of course, many hospitals rank themselves based on patient satisfaction scores.  The patient survey affect hospital quality ranks, which have many variables including when did the patient fill out the survey or what patients filled out the survey.   New parents, for example, are prime targets for a patient survey score.

Kaiser Health News noted the patient satisfaction scores drive hospitals in the story they did about hospital food going gourmet.  Link here. 

Hospitals are introducing upscale food on-demand just like a hotel’s room service not only to boost scores, but also to raise revenue.  Uneaten food is wasted money in terms of disposal costs.  Better food, as Kaiser reports, means patients don’t complain when they’re told to stay an extra day.

Meanwhile, a non-profit organization, The Leapfrog Group, ranks hospitals as well as states based on patient safety and patient outcomes, which they term “never events,” as they should never happen.  This includes falls, infections, surgical items left inside patients, etc.  Link here.  

Much of this data, however, depends on hospital self-reporting, including an annual hospital survey that Leapfrog send out.  Some hospitals, even in Minnesota, do not return the survey.

Considering the link between nurse staffing and patient safety, it will be interesting if the media and watchdog groups, such as Leapfrog, pick up on this reporting data and include it as part of their future hospital rankings.

Minnesota’s HMOs continue to bank huge surpluses.  According to health care analyst Allan Baumgarten’s report, which was cited here by the Twin Cities Business Journal, health plans in the state collectively socked away $241 million in 2012.  That’s up from 2011 profits of $230 million.

HMOs living high on the hog with huge surpluses

HMOs will disagree with the word profits, as they’re non-profits, but their revenues combined mean they’re now sitting on $1.9 billion in savings.  State law require them to save money to remain solvent, but the latest figures show the state’s health plans are now banking $1.3 billion more than regulations require.

HealthPartners alone generated nearly $128 million in operating income over the past two years, which earns it the title of most profitable HMO in the state.  That means employers and their employees are grossly overpaying HMOs for medical coverage.   A bill, however, that would require HMOs to only maintain a net worth limited to just 25 percent of their expenses never saw the light of day in the legislature last year.

The TCBiz Journal reports the HMOs have also applied to sell coverage on the MNSure Exchange next fall, and Baumgarten expects these insurers will be offering limited range of provider coverage on the network to keep costs down and profits up.

Could the threat of malpractice spur the fight for better nurse staffing?

When the Robert Wood Johnson Foundation and the National Institute on Nursing Research released a study on the effects of nurse staffing in NICUs, it was a unique look into how nurse workloads affect non-adult patient outcomes.  The study was conducted by researchers from the University of Pennsylvania, University of Medicine and Dentistry of New Jersey, Ohio State University, Dartmouth College, and the University of Vermont.  Data was collected at 67 Vermont-Oxford Network hospitals on very-low-birthweight (VLBW) babies hospitalized between 2008 and 2009.  Surveys on nurse staffing levels and patient acuity levels were tracked daily.

The result was not surprising.  The researchers say that staffing below national guidelines by just .1 nurse-per-infant led to a shocking 40% increased risk of infection.  Just one-tenth less.   What’s more is the hospitals studies were considered to have excellent nursing care and staffing levels, but even these hospitals were found to be understaffing below national standards by 47 percent in 2008 and 31 percent in 2009.  The sickest babies were understaffed the most.  On a scale of 1 to 5, the sickest category 4 and 5 babies were found to be understaffed 80 percent of the time in 2008 and 68 percent in 2009.  The full study was published in the Journal of Pediatric Medicine and here at MedScape News (sign-up required).

The Illinois Medical Malpractice website picked up on the study too.  What’s interesting is malpractice attorneys cite staffing as not a one-time error, but a “symptomatic” error that’s caused directly by administrator decisions to keep costs down.  That’s a conscious decision that has a direct effect of increasing the chance of infection and possibly long-term care for a patient.  The attorneys write that, “it is absolutely incumbent up all facilities not to prioritize profits over patients in this way.”  link here

What if the threat of malpractice forced hospital administrators to take a closer look at the staffing decisions they make every day?