Arkansas Agency Receives $1 Million Grant
The Arkansas Center for Health Improvement (ACHI), lead agency for the Southern Rural Access Program effort in Arkansas, recently received a $1 million grant from the federal Health Resources and Services Administration to support planning efforts associated with the Arkansas Health Insurance Expansion Initiative. 

The ACHI will lead a coalition of state government leaders, healthcare purchasers and providers, consumers, and risk managers in developing and specifying plans guided by empirical information for expanding health insurance coverage in Arkansas. The Arkansas Health Insurance Expansion Initiative is designed to:

• Establish the Arkansas Health Policy Roundtable, a multidisciplinary project team, to guide the State Planning Grant Program.
• Examine and summarize existing information on health insurance status in Arkansas.
• Collect and analyze qualitative and quantitative data concerning insurance coverage in Arkansas.
• Identify, evaluate, and prioritize options for expanding insurance coverage.
• Generate and submit final reports to Governor Huckabee, the General Assembly, and the Secretary of the federal Department of Health and Human Services.

According to Dr. Joe Thompson, principal investigator for ACHI, the Arkansas project will provide the first systematic statewide collection of information from households and employers regarding availability and need of health insurance.

Stark II Rule, Part 1
The federal Department of Health and Human Services (HHS) published the first of what it said will be a two-part installment of the final regulations to implement the 1995 "Stark II" law in the January 4 Federal Register. The law bars physicians from referring Medicare patients to laboratories, suppliers, home health agencies, and other companies with which they maintain a financial relationship. 

The second installment of the rule will address physician ownership interests and compensation arrangements between physicians and hospitals and other entities, and will have a greater impact on hospitals.

Part 1 primarily focuses on physicians’ offices and group practices. For example, the rule broadens the exception for services provided in a physician’s office or part of a group practice. 

The release date for Part 2 is questionable, since the January 4 rules have a 90-day comment period and HHS said it wants to review comments on the January 4 regulation before issuing the second installment. 

The new rule contains some areas of keen interest for hospitals. It makes clear that hospitals and other entities will not be penalized for providing services if they did not know or had no reason to suspect that a doctor made an improper referral. Under the proposed rule, Medicare claims in these situations would be denied. Exceptions are made for "incidental benefits" hospitals provide to medical staff, like providing meals to physicians and giving them access to library services. 

For more on the regulations, go to www.hcfa.gov/regs/physicianreferral/default.htm.

Sharps Injury Prevention Guide Available
The American Hospital Association (AHA) has developed for its members a sharps injury prevention guide that provides information about how to comply with federal needlestick safety regulations issued by the Occupational Safety and Health Administration.

Two key areas of the new law are involvement of frontline workers in the identification and evaluation of safe needle devices and a requirement for a log of sharps injuries in healthcare settings. As of April 18, hospitals and health systems will be required to solicit the front-line workers’ input on sharps devices.

To help its members comply with the new log requirement, the AHA has designed a model sharps injury log that can be modified for individual facility use. The log requests information regarding the sharps device used, location and severity of the injury, and the procedure in which the injury occurred. The advisory and guide are available in the members’ section of the AHA Sharps Safety site at www.aha.org/needle.

Arkansas Patient Safety Initiative
A group of eleven Arkansas healthcare provider organizations, including the Arkansas Hospital Association, have joined forces to improve patient safety in the state. The Arkansas Patient Safety Initiative (APSI) has been under development since about a year ago when the Institute of Medicine released its report, To Err is Human: Building a Better Health System, which said up to 98,000 Americans die each year as a result of medical errors.

Dr. William Golden, clinical coordinator for the Arkansas Foundation for Medical Care (AFMC), one of the APSI founding groups, said the focus of the initiative will be on preventing medical errors, particularly those attributable to limitations in processes a healthcare organization has in place. Golden said the alliance of leaders can work closely with their constituents and members to promote improved systems.

One goal of the APSI is to alleviate providers’ fears of reporting errors that could result in punitive action without benefit to either the provider or patients. The APSI aims to change that climate by creating an educational, non-punitive forum where questions and incidents can be discussed openly so that solutions can be implemented, according to David Wroten, assistant executive vice president of the Arkansas Medical Society. The open discussion should make solutions to the problems more attainable.

The APSI will begin its educational focus with three initiated project priorities. They are appropriate dosing among pediatric and geriatric patients, safe use of medications in the home, and appropriate usage of antibiotics to prevent post-operative infections. The coalition will work to educate the healthcare community by sharing resources, sponsoring seminars, distributing educational materials, and supporting local patient safety initiatives.

Coalition members include the AHA, AFMC, Arkansas Medical Society, Arkansas Nurses Association, Arkansas State Boards of Nursing and Pharmacy, the Arkansas Pharmacists Association, Arkansas Association of Hospital Pharmacists, Arkansas Health Care Association, and the Arkansas Departments of Health and Human Services.

IOM Issues Second Safety Report
The Institute of Medicine (IOM) March 1 issued its highly-anticipated follow-up report on healthcare in America that ¾ unlike the first report, which focused on medical errors ¾ proposes wide-ranging steps to improve the nation’s healthcare delivery system.

The authors of the report, Crossing the Quality Chasm: A New Health System for the 21st Century, proposed that Congress spur the overhaul with creation of a $1 billion “innovation fund” for use during the next three to five years to help subsidize promising projects and communicate the need for rapid and significant change throughout the health system.

The IOM’s Committee on the Quality of Health Care in America issued 13 recommendations in the report, all intended to make healthcare safe, effective, patient-centered, timely, efficient, and equitable. The committee spoke quite frequently of the need for fundamental change in the system. Among the recommendations:

• Healthcare organizations, professional groups, and private and public purchasers of healthcare services should explicitly adopt as a purpose the continual reduction in America’s burden of illness, injury, and disability.
• There should be establishment of monitoring and tracking processes to evaluate the progress of the health system in pursuing its quality aims, with an annual report by the HHS secretary to Congress and the president on the quality of U.S. healthcare.
• Healthcare processes should be redesigned to reflect: continuous healing relationships, customization based on patient needs and values, the patient as the source of control, shared knowledge and the free flow of information, evidence-based decision making, safety as a system property, transparency, anticipation of needs, continuous decrease in waste, and cooperation among clinicians.
• The Agency for Healthcare Research and Quality should identify at least 15 priority conditions and, in collaboration with the National Quality Forum, should convene stakeholders to develop strategies, goals, and action plans for improving quality in the next five years for each priority condition. 
• There should be a renewed national commitment to building an information infrastructure to support healthcare delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education, with the goal of eliminating most handwritten clinical data by the end of the decade.

The American Hospital Association (AHA) said it agrees with all areas of focus listed in the report, but said that some caution is needed to ensure that there is no duplication of effort, timelines are realistic, and that everyone involved clearly recognizes the resources needed to successfully implement these ideas.  For more, information, go to www4.nas.edu/onpi/webextra.nsf/web/chasm?OpenDocument.

The Leapfrog Group Calls for Higher Patient Safety Standards
In response to reports of preventable medical errors, The Business Roundtable unveiled a forceful, market-based effort to improve patient safety across the nation.  The group also released new research indicating that the approach could save up to 58,300 lives and prevent up to 522,000 medication errors each year.

The new program is called “The Leapfrog Group,” a growing consortium of Fortune 500 companies and other large private and public healthcare purchasers.  The Group’s approximately 60 members provide health benefits to over 20 million people and spend more than $40 billion on healthcare every year.

Based in Washington, DC, The Leapfrog Group plans to press for aggressive safety standards in hospitals and to use buying clout by steering their companies’ employees to hospitals that provide higher levels of care according to their Evidence Based Hospital Referral (EBHR) system.  Members plan to send their employees to hospitals that:

• Have computerized physician drug order entry systems
• Perform high-volumes of certain high-risk surgeries
• Staff their critical care units with physicians who are specialists in intensive care

To learn more about The Leapfrog Group, visit its Web site at www.leapfroggroup.org.