Knowledge Center
National Patient Safety Efforts Save 125,000 Lives and Nearly $28 Billion in Costs

Hospital-Acquired Conditions (HACs) are 28 specific conditions that are not present on admission but are instead “acquired” during a stay.  Essentially, HACs are conditions that a patient develops while being treated for something else by a provider.  Examples of HACs include largely preventable conditions, including falls, pressure ulcers, adverse drug events and serious infections, such as catheter-associated urinary […]

Multiple studies confirm that Medicare’s payment reduction policies for complications has not resulted in reductions in complications.

The CMS policy of withholding additional Medicare payment for mediastinitis was not associated with a reduction in actual infection rates during the first 2 years after policy implementation. Similar findings were associated with catheter-associated urinary tract infections (CAUTIs), which actually continued to rise after Medicare instituted payment reduction policies. Notwithstanding the lack of reduction or […]

PurpleLab identified HCOs other than those previously identified by the Department of Justice who appear to have violated the National Coverage Determinations (NCDs) establish by Medicare regarding the appropriate use and billing/reimbursement for Implantable Cardioverter Defibrillators (ICDs).

In 2015, the United States Department of Justice reached 70 settlements involving 457 hospitals in 43 states for more than $250 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare National Coverage Determinations (NCDs). The NCD provides that ICDs generally should not be implanted in patients who have recently […]

Studies demonstrate an inverse relation between volumes of surgical procedures performed in hospitals and related mortality.

Patients undergoing high risk surgical procedures can significantly reduce their risk of post operative death by selecting a high-volume provider versus a low volume provider. A study covering mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million) demonstrated […]

Why Not The Best? How About The Worst? In Measuring Preventable Mortality Among 19 Industrialized Nations, U.S. Ranks “Dead Last”!

In a study by The Commonwealth Fund, The United States ranked last among 19 industrialized nations on “preventable mortality” which were defined as “mortality amenable to health care—deaths that might have been prevented with timely and effective care”. Although the U.S. rate improved by 4 percent between 1997–1998 and 2002–2003 (from 115 to 110 deaths per […]

Relationship between surgeon volume and outcomes: a systematic review of systematic reviews

A systematic review of 32 separate systematic reviews, yielded a trend of surgeon volume-outcome relationship for the following procedures/conditions: AAA, cystectomy, esophageal cancer, head and neck cancer, lung cancer, pancreatic surgery, radical prostatectomy, and total knee arthroplasty.  Overall, the systematic reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in […]

Complications account for nearly 10 percent of inpatient hospital costs

Potentially Preventable Complications (PPC) identify potentially preventable harmful events or negative outcomes originating during inpatient care that result from the processes of care and treatment rather than from the natural progression of underlying disease. PPCs containing 64 mutually exclusive types of inpatient complications that are identified from 1,450 ICD-9 secondary diagnosis codes – not present […]

Nearly 500 Hospitals Pay United States More Than $250 Million to Resolve False Claims Act Allegations Related to Implantation of Cardiac Devices.

The Department of Justice has reached 70 settlements involving 457 hospitals in 43 states for more than $250 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare National Coverage Determinations (NCDs). The NCD provides that ICDs generally should not be implanted in patients who have recently suffered a heart […]

Mortality and Readmissions are not inversely related

Median RSMR was 16.57% for AMI, 11.06% for HF, and 11.46% for pneumonia. The RSMRs ranged from 10.90% to 24.90% for AMI, from 6.60% to 19.85% for HF, and from 6.36% to 21.58% for pneumonia. The median RSRR was 19.87% for AMI, 24.42% for HF, and 18.09% for pneumonia. The RSRRs ranged from 15.26% to […]

Complications account for nearly 10 percent of inpatient hospital costs

Potentially Preventable Complications (PPC) increased lengths of stay for inpatient admissions resulting in dramatically increased total costs of care. A study of 3 hospitals for two 9 month periods showed that two PPCs — urinary tract infection and pneumonia – experienced substantially longer inpatient stays than those who did not suffer from these PPCs. Patients […]

Critical Access Hospital (CAH) can opt out of Medicare quality measures, including those published on the Hospital Compare website as well as those on Quality.net.

Critical Access Hospital (CAH) designation was established to provide rural residents local access to emergency and inpatient care. CAHs – while exempt from comparison to non-CAH hospitals – demonstrate worse outcomes. CAH hospitals show worse short-term outcomes for pneumonia, heart failure, and myocardial infarction compared to other non-CAH hospitals.

Unnecessary / Otherwise Preventable Deaths Occur Each Year

The National Academy of Medicine (NAM), previously known as the Institute of Medicine (IOM), found as far back as 1999 – that as few as 44,000 people and as many as 98,000 people – die in hospitals each year as a result of medical errors that could have been prevented according to estimates from two […]

Studies demonstrate an inverse relation between volumes of surgical procedures performed in hospitals and related mortality.

Major Findings: While there are low-volume hospitals that provide excellent care and high-volume hospitals that provide relatively poor care, numerous studies confirm that patients undergoing Coronary Artery Bypass Graft (CABG) surgery by a low volume HCP provider or at a low volume HCO provider have a significantly higher risk of mortality compared to patients undergoing […]

Accounting For Patients’ Socioeconomic Status Does Not Change Hospital Readmission Rates

The recently signed 21st Century Cures Act requires Medicare to account for patient socioeconomic backgrounds when it calculates reductions in its payments to hospitals under the Hospital Readmissions Reduction Program (HRRP).  This, provision was included in the Cures Act despite an active public debate about whether patients’ socioeconomic status should be included in the readmission measures […]

The Association Between Hospital Characteristics and Rates of Preventable Complications and Adverse Events

Hospital characteristics have long been viewed as variables to be used in either risk stratification or risk adjustment measures.  The long held views were that teaching hospitals and urban hospitals have disproportionate shares of sicker patients.  Hospital size (by numbers of beds), hospital teaching status (Y/N as well as residents/bed count ratios), hospital location (within a […]

Studies demonstrate an inverse relation between volumes of surgical procedures performed in hospitals and related mortality.

Patients undergoing high risk surgical procedures can significantly reduce their risk of post operative death by selecting a high-volume provider versus a low volume provider. A study covering mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million) demonstrated […]

Risk Readiness

Ultimately, what PurpleLab enables is to understand which providers are ready and able to manage the “risk” they will incur under value-based reimbursement programs such as “bundling”. As reimbursement models shift from Fee-For-Service to “Bundling”, risks shift from the payers to the providers. PurpleLab provides a “lense” over each provider’s (HCP, HCO Group and HCO […]

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