Both New York State and New York City Take Bold Steps to Try To Improve Health Care

New York Governor Andrew M. Cuomo announced that the state will work with hospitals this year to improve the quality and safety of care provided to patients at key stages of hospital admission, treatment, and discharge, and more particularly with respect to sepsis. Sepsis is the number one cause of death in U.S. hospitals, striking at least 750,000 people in the country each year, and kills as many Americans annually as heart attacks, and more than AIDS, prostate cancer, and breast cancer combined. Also, the New York City Health and Hospitals Corporation (HHC) announced a new pay-for-performance agreement that will reward doctors with up to $59 million in incentive payments over the next three years for meeting the public hospitals system’s goals to improve patient care, efficiency, patient satisfaction and align with the new demands of healthcare reform.

Governor Cuomo announced that New York will lead the nation by being the first state to require all hospitals to adopt best practices – including an innovative checklist modeled off a proposal by Harvard’s Atul Gawande – for the early identification and treatment of sepsis. The new steps could save 5,000 to 8,000 lives annually, state health officials say, and reduce the long-term costs of the condition. In some cases the failure to either timely diagnose or treat sepsis can give rise to a medical malpractice case, and sometimes sepsis can be a complication resulting from medical malpractice.

Strategies to prevent sepsis include five key “best practices”: remove unnecessary lines, hand hygiene, use of maximal barrier precautions, chlorhexidine for skin antisepsis, and avoid femoral lines.

HHC’s new pay-for-performance program will reward physicians based upon performance factors including:

  • care coordination;
  • patient satisfaction survey scores especially concerning doctor-patient communication and communication about new medications;
  • reducing 30-day readmission rates from congestive heart failure and pneumonia; maintain on-time start times for surgery;
  • reduce the amount of time from triage to exit from the emergency room for patients who are admitted to the hospital; and
  • reduce average length of stay in the hospital.

Much of the impetus for the program comes from the decrease by the Centers for Medicare and Medicaid Services (CMS)in Medicare reimbursement to hospitals for patients who are excessively readmitted to the hospital within 30 days of their last admission, and from the coming application by CMS of value-based purchasing criteria, including patient satisfaction scores and adherence to certain evidence-based best clinical practices that can decrease or increase Medicare rates by 1% this coming year and by 2% in 2017.

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