Top Healthcare Quality Issues for 2014, Part 1

Cheryl Clark, for HealthLeaders Media , January 6, 2014

And, the agency said, "Evidence also shows variation in readmissions of patients with THA/TKA procedures, supporting the finding that opportunities exist for improving care."

The agency added COPD to the algorithm because the median 30-day risk-standardized readmission rate for COPD in 2008 "was 22%, and ranged from 18.33% to 25.03% across 4,546 hospitals."

3. HAC Penalty To Cut 1%
The Patient Protection and Affordable Care Act called for a brand new penalty against hospitals whose rates of hospital-acquired conditions falls into the top quartile, starting Oct. 1, 2014, affecting up to 1% of a hospital's Medicare DRG payment. The equation consists of two parts. One is called patient safety indicator or PSI-90, an amalgamation of 11 indicators of harm including pressure ulcers, hip fractures, sepsis, and deep vein thrombosis.

The second category is a combination of the hospital's rates of central line-associated bloodstream infections (CLABSI) and its rates of catheter-associated urinary tract infections (CAUTI).

4. Videography in Surgical Skill Peer Review
Might surgeons soon be rated based on videos of their work?

A New England Journal of Medicine paper may have some surgeons and their medical executive committees trembling in fear or cracking open champagne. The study found that when surgeons watched procedure videos and rated their peers on skill and technique, their high or low ranking correlated well with the patient's actual outcomes and complications.

The surgeons were allowed to submit videos of what they considered their best work.

Not only did the reviewers find enormous variation on a 1 to 5 point scale, patients whose surgeons were ranked lower had twice the rate of death and other postoperative preventable events, such as readmissions and reoperations, as the surgeons who received the best scores.

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