How Hospitals Can Reduce Risk By Limiting Patient Transportation for ImagingPosted on: 06.28.19
Transporting patients for any reason, especially the critically ill, is a risky prospect.
Yet there are a number of reasons why a hospital may need to move a patient. Imaging is just one of those, with patients being moved to different parts of the hospital or even off premises where needed imaging equipment isn’t available.
For any clinic, managing or mitigating that risk is vital. Not only is it important for the care of the patient, but because hospitals increasingly are held responsible for any consequences of those risks.
Where CMS used to cover incidents such as infections in patients, they are often refusing to, putting the liability on the hospital. This makes limiting patient transportation and its inherent risks a priority.
The risks associated with patient transport
Typically, when a patient needs to move from their room in a hospital to receive treatments, tests or imaging elsewhere, they are not permitted to walk to those places themselves. Patient transport involves a healthcare worker taking them, usually via wheelchair or stretcher.
Transporting a patient requires knowledge, skill, good equipment and communication between patient and healthcare workers. Any of those things can break down and lead to injuries, ranging from minor scrapes to a traumatic brain injury or death, particularly as a result of a fall.
There are tens of millions of hospital admissions in the United States each year. Each of those represents a possible opportunity for a patient transport accident, even if each person is only moved once.
The prevalence of adverse events during patient transport is relatively high. Incidents happen often, although it is estimated that a large proportion of those go unreported. In one study, 45.8% of patient transports were associated with an adverse event, from minor to major. In another study, 67.9% of patient transports observed were associated with an “Unexpected Event.” These are some significant numbers – risk during patient transportation is a significant issue.
A study looking at the risks of patient transport for the critically ill highlighted a host of other risks besides transport accident. These include:
- Potential for infectious exposure
- Ventilator-acquired pneumonia
- Pulmonary complications
- Cardiac arrest
- Equipment dislodgement
- Interruption of therapy or care.
Particularly with critically ill patients, the risks of transporting them often outweigh the benefits. This creates a dilemma for clinicians, especially when imaging or testing is needed to help them form a thorough treatment plan.
Transporting someone who is critically ill can present more challenges, such as needing to transport therapy equipment with them and often requiring more healthcare workers for the process. Not only is it risky, but it is labor-intensive.
The risk of infection being spread via patient transportation is very well-known and very high. It has been noted repeatedly in hospitals where patients are moved between wards for non-clinical reasons, such as lack of space. Transfers hobble a hospital’s ability to contain infections and put both the transported patient and others whom they come directly or indirectly into contact with at risk.
Another review highlights that: “As the transfer of sick patient may induce various physiological alterations which may adversely affect the prognosis of the patient, it should be initiated systematically and according to the evidence-based guidelines.”
Increasingly, the Centers for Medicare and Medicaid are holding hospitals liable for any consequences as a result of patient transport. Given that hospitals are measured in many ways now, including patient outcomes, most are vitally aware of the risks involved with patient transport and have policies to mitigate them.
Limiting patient transportation
It makes sense to limit patient transportation to only when it is absolutely necessary. Fortunately, with improvements in technology today, many tests, therapies and imaging requirements can now be carried out from the patient bedside.
Point of Care imaging, where imaging needs can be carried out at or very near to the point of care is one such solution to mitigate risk. Point of care minimizes the risk of infection, or the spread of current infection, as well as the risk of any transport accidents.
Vulnerable patients can be susceptible to bed sores, cuts and grazes during transport. These seemingly minor issues can result in months of treatment for those most at-risk. By minimizing movement, these negative impacts are also minimized.
Reduced patient stays and improved overall experience
With minimized risk of illness, infection spread, or injury during transport, the total hospital stays for patients can also be reduced. The patient has better outcomes and the hospital improves patient throughput.
From the patient perspective, the overall experience can be improved by using Point of Care imaging. They get to stay in the relative comfort and security of their own room while the imaging equipment comes to them. For many ill or injured patients, transport of any kind brings huge discomfort – this is one way that hospitals can improve their experience.
Improved clinical research and efficient use of resources
When you consider that the extent of illness or injury may prohibit a patient from being transported to receive imaging, portable equipment represents a game-changer. Bringing the imaging to the patient in these cases allows for clinical research that may be transformative, and that may otherwise have not been conducted.
Hospitals should also consider that Point of Care imaging helps them to make more efficient use of their healthcare workers. Transportation of injured or ill patients can involve an entire team of people, whereas portable imaging only requires one employee: a Nuclear Medicine Technologist (NMT).
Portability in the OR
Portable imaging is also making an impact in the OR. The Digirad Ergo Imaging System was highlighted in the Journal of Pediatric Surgery for the improvements it makes to the OR environment.
Specifically, a major risk of any OR is the time spent by the patient under anesthesia. The longer the patient is under, the more risky it becomes. When surgeries require imaging to go ahead, in many cases (such as lymph node biopsies in children), it is necessary to sedate the patient, undergo mapping in a nuclear imaging suite, then transport them to the OR for surgery. This extra step in the process adds to transport risk and to the risk of time under anesthesia.
Point of Care imaging means that those images can be acquired in the OR, the area prepared, then the surgery can begin without delay. This also reduces downtime in the OR. When the procedure and the surgery are done in one environment, it’s safer for the patient, spares them additional time under anesthesia, and alleviates the need for transport.
Patient transport is inherently risky for hospitals and the patients they care for. Accidents, infection spread and deteriorated patient states as a result of transport are relatively common and can severely set back recovery times.
It makes sense to limit patient transport where possible, and implement Point of Care therapies, tests and diagnostics. Portable imaging is one way to reduce infection spread and achieve better outcomes for patients and hospitals.
Most critical imaging needs can be catered for at the patient bedside. For hospitals, this can be an investment with great returns.
Reimbursement Radar: How 2019 rule changes from CMS will affect cardiologistsPosted on: 12.13.18
On November 23, 2018, the Centers for Medicare & Medicaid Services (CMS) published the final rule changes for the 2019 calendar year. How will they affect nuclear medicine and your practice in particular? After all the noise in 2018, the changes were minimal. It seems that 2019 will be following suit:
Hospital procedure rates remain nearly static
On the hospital side, CMS has continued to evaluate and adjust the cost of procedures that are either under- or overvalued. The majority of nuclear medicine procedures will see a minimal increase of between 0.5% and 2.2%. The slightly more significant but far from dramatic adjustments will be made to codes for administering radiopharmaceutical therapies, which will see a decrease of 3.3%.
One notable change was made in direct response to the administrative burden that meaningful use measures and quality reporting placed on providers. In 2019, not only will no new meaningful use and quality measures be implemented, but CMS will look to reduce the current policy. The reduction is aimed at allowing providers the ability to focus on the measures that are most meaningful and impactful on their patient care.
Site neutrality payment cuts
More interesting, however, was CMS’ decision to neutralize payment variances between the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. By implementing a Physician Fee Schedule (PFS)-equivalent payment rate for an off-campus provider-based department (PBD) clinic visit that is paid under the OPPS, patients will benefit from high-quality care and lower copayments.
In order to further evaluate the unnecessary increases they’ve seen in services rendered at PBDs, however, CMS will establish a moratorium on the addition of any new off-campus PBDs. Existing locations will continue with business as usual, and CMS will monitor the total amount of payments made under the current arrangements. Any follow up to this issue will likely be addressed in the 2020 or 2021 ruling.
Physician fee schedule sees positive change
Overall, current projections are seeing a negligible increase, barely 1%, in nuclear medicine. Procedure rates are slated to remain largely the same, based on the national unadjusted average.
An additional year for AUC preparation
One of the biggest reliefs in the final ruling has to do with the effective date for adherence to authorized use criteria (AUC), which has been postponed numerous times and last slated to take effect on July 1, 2019. Many of the medical societies voiced their concern about the preparedness of providers and their ability to implement a new system by mid-year. CMS responded by designating 2019 as an education year with a revised effective date of January 2020.
How practices are making the shift to Value-Based carePosted on: 04.19.18
When you think about positioning your practice for success and overall sustainability, the transition to value-based care should be one of the first things that comes to mind. The shift from the fee-for-service model is no longer a trend, but a critical necessity in today’s healthcare environment. The value-based approach is the future of patient care and resisting–or even hesitating–will cost your practice the loss of potential revenue and overall viability.
The central idea behind value-based care is to create a system that is not measured solely by services rendered. Its objective is rooted in redefining quality care by enhancing both patient outcomes and experiences, and improving the health of the patient population, while ultimately reducing the increasingly high costs of healthcare.
Transitioning to this new school of thought will include modifications to organizational workflow and a move away from episodic care. Here are a few practical steps you can take as you prepare your practice for value-based success.
Know your patient population
Under the value-based reimbursement model, patient analytics is a critical factor in population health management. Patients with the highest risk of hospitalization, such as chronic or complex conditions, typically incur the highest health care costs. They’re also the ones who suffer most from fragmented care. Identifying this population will help you isolate areas for improvement.
Analytics also use trends to reveal gaps in care by identifying individual patients who may be accessing health care outside of the traditional channels. For example, when and why do patients visit an urgent care facility or emergency room? Is it after hours or on the weekend? Had they been recently discharged from the hospital? Implement a solution that drives utilization toward a high-quality, lower-cost alternative. Ultimately, patients must feel their needs are being met without going outside the box. In some instances, enrolling patients in a care transition program might be the answer.
Analytic software can also help you identify other unnecessary costs. Compare costs for imaging services used by your practice or the cost of supplies. Your findings may reveal that an imaging center used by your practice is more expensive than another comparable one in your area. That’s an easy way to reduce expenses.
Invest in the right technology
With value-based care reimbursement, it’s critical to employ the technologies that support your overall goal. Clinical decision support tools provide the knowledge and patient-specific information that enhances decision-making in the clinical workflow and ultimately improves care. By providing a playbook of protocols, these tools eliminate waste by minimizing unnecessary tests. They also improve patient safety by giving providers access to a patient’s complete medical records, a comprehensive view of their overall health, and a method of easily and quickly sharing patient data with other health systems as needed.
Improve patient engagement
Engaging patients in their health and care is a critical component of value-based care. Patients who are engaged have greater knowledge, ability, skills, and willingness to successfully manage their health and are more compliant with doctors’ orders and recommendations. Investing in engagement leads to better outcomes and lower costs, which are both critical in value-based care.
Patient portals are an ideal method of improving engagement because you effectively give patients access to your practice and a level of control that empowers them. Enrollment, visit summaries, online appointment booking, collecting family health history, and email communication are just some examples of the value and efficiency it can offer your practice and your patients.
Couple that with the creation of care teams who follow patients through their care cycle and beyond, you allow for a more longitudinal care approach. This approach can bring about sustainable change in your patient relationships and how they view their care.
Each step on the way to value-based care should be viewed as a learning experience. As these experiences provide you with more knowledge and understanding about what works best, you can make the changes that will better meet your patient needs.