CT Center for Patient Safety Newsletter

July 2015

In This Issue

Jean Rexford, 2015 Carlson Honoree

Surprise Medical Charges

July Health Hints

Not everyone defines a health emergency the same

How are Connecticut residents affected by the Supreme Court ruling on subsidies?

Care Partner Programs: Advancing Advocacy at the Bedside

The staggering differences in Hospital Charges

Jean Rexford, 2015 Carlson Honoree

At the 2015 Carlson Forum and Annual Meeting of the Connecticut Coalition on Aging, Jean Rexford was the Carlson Honoree for her work on behalf of Connecticut's seniors. Congratulations, Jean!!

Surprise Medical Charges

Did you know that in some cases where one of your providers has multiple offices, some of them may not be on your insurer's in-network offering while others may be? And were you aware that even though you may have chosen to use an in-network hospital, some of the physicians providing services there may not be in your network? While this may not seem logical to you, it is what patients across the country have found. Fortunately, individual states are beginning to address this problem through legislation.

This past April, New York enacted legislation that said that extra bills for out-of-network emergency care, when an in-network provider is unavailable or when they aren't told ahead of time that they may be treated by a non-participating provider must be settled in arbitration between the providers and the insurance companies. Connecticut residents just saw legislation passed in the 2015 session that is awaiting the Governor's signature. It says that in similar cases of surprise billing, "An insured shall only be required to pay the applicable coinsurance, copayment, deductible or other out-of-pocket expense that would be imposed for such health care services if such services were rendered by an in-network health care provider; and a health carrier shall reimburse the out-of-network health care provider or insured, as applicable, for health care services rendered at the in-network rate under the insured's health care plan as payment in full, unless such health carrier and health care provider agree otherwise."

The legislation is complicated, but for those interested in reading it, as it currently stands, it can be found at the Connecticut General Assembly site.

July Health Hints and Resources for a Hospital Stay

While emergencies do happen and you may have no choice but to go to a hospital, when the choice is yours, July may not be the best time to schedule your surgery. Due to the influx of new residents replacing the more experienced residents around the first of July in our nation's teaching hospitals, there have been multiple studies of what is called the "July Effect". One study from 2010 found that fatal medication errors consistently spiked in July by about 10 percent in U.S. counties with many teaching hospitals - and then subsided in August back to prior month's levels. Another study found that patient death rates increase while efficiency in patient care decreases during the month of July.

If you find yourself in a hospital during the summer months, or at any time, a rich resource that you can access for free is

The Empowered Patient® Hospital Guide For Patients and Families and

The Empowered Patient® Journal: A Companion Journal for the Hospital Guide For Patients and Families

Not everyone defines a health emergency

in the same way

This is where the business of insurance and the reality of life and life events may be out of sync! In a recent article, it was pointed out that while your insurance company has to cover you in an emergency if you are taken to a nearby out-of-network hospital, they do not have to continue to cover you

once you are stabilized. In fact, they may require you to transfer to an in-network doctor or hospital at that point, or you may be responsible for the cost of your care. Moreover, just when you thought that your maximum out of pocket would control your costs, unless you have a plan that allows out-of-network coverage (usually with its own maximum out-of-pocket), the sky may be the limit! For many, the emergency itself may make it next to impossible to make the necessary decisions related to a transfer once the patient is "stabilized". If this is an issue, most hospitals now have patient relations personnel or care coordinators on staff who you or a family member can speak with and who can help the patient manage their care.

How are Connecticut residents affected by the Supreme Court ruling on subsidies?

The Court upheld health care subsidies for everyone. This ruling had significant impact for residents of states which do not operate their own marketplace and use the federal marketplace for their residents to purchase insurance. Their tax-credit subsidies would have ended if the ruling went the other way. While the impact is less for Connecticut residents, the ruling will allow almost 6.5 million Americans to continue to receive the subsidies and be able to afford health insurance. It is anticipated by many that this will lead to steadier insurance costs and coverage for everyone, including those Connecticut residents who rely on Access Health CT, the Connecticut exchange, to purchase their insurance.

The following panel discussion, from Kaiser Health News, offers a comprehensive discussion of the Supreme Court decision:

Please Don't Forget we have a donor who will match your donation dollar for dollar

Will your employer match your donation?

Dear Members,

The Connecticut Center for Patient Safety is busy this summer:

We are pleased with the omnibus health care bill (SB 811; Public Act No. 15-146) that came out of our state's legislative session. This bill increases transparency and protection for Connecticut's patients. We will continue to follow it as its provisions are put in place.

An exciting new project that we are launching will include an online "support group" for patients who have experienced medical errors or medical harm and are looking for a supportive environment where they can learn from each other. As soon as this is available, we will be sending out a notification.

You will see a new monthly column in this newsletter. Jim Kinsey, Director Planetree Member Experience will be contributing articles focused on concerns relevant to our senior members. We are happy to address some of the unique issues that seniors face and welcome your input and topic suggestions as well.

Our nursing school education initiatives are taking place in classrooms throughout Connecticut where we will be bringing our stories and patient safety information to a number of graduating nursing students this summer.

Finally, I am VERY excited to announce that we have received a matching challenge donation of up to $50,000 to support an expanded educational program geared towards bringing the patient experience to medical residents, medical students, advanced nursing students and other health science students in Connecticut. This is your opportunity to support us by donating any amount that you can, and our matching donor will double the impact of your donation! Remember, our attendees will be the health care leaders of tomorrow! Let's not let a penny go to waste.

Lisa Freeman

Care Partner Programs: Advancing Advocacy at the Bedside

Jim Kinsey, Director Planetree Member Experience

As of this writing, 14 states, including Connecticut, have passed the Caregiver, Advise, Record and Enable Act (CARE). These legislative programs require hospitals to identify, educate, train, and support family caregivers. If you are not currently living in one of the states that has this act, chances are that very soon you will see similar legislation in your area. But, what does this mean for the patient and their family caregivers? And, what should the healthcare consumer look for when assessing these programs?

First, celebrate the acknowledgement that states have recognized the importance of family caregivers. This is a huge step towards activating patients and families as members of the care team and to insure their voice is heard!

Second, what should be the expectation of these programs and how can the family caregiver be part of transforming the relationship between healthcare staff and patients? The CARE Act has three core provision that require hospitals to:

Record the name of the family caregiver in the patient's medical record when they are admitted for treatment.
Inform the family caregiver when their loved one is to be discharged.
Provide the family caregiver education and instruction on the medical tasks they will need to perform at home.

These requirements are the minimal for hospitals to comply with the act; advocacy should focus on having healthcare providers go above the minimal requirements to include family caregivers in activities, such as:

Providing physical care
Assisting with meals
Participating in physical therapy
Monitor fluids and intake
Providing that extra set of eyes and ears to recall instructions, procedures, and questions that need to be asked

The key to these programs being successful will be for hospitals and other healthcare agencies to capture the voice of the patient and family caregiver in the development process. Identifying what is important for the patient and caregiver to participate in, and having access to and how to fulfill education needs will be an essential step in creating successful programs and providing family caregivers with the skills needed to feel effective in their role.

When an elder is receiving care in a hospital, these family caregivers become an important linkage to successful outcomes. For many elders, being in the hospital is a cognitive-altering event; the noises, the amount of people coming in and out of the room, changes to medication, etc. all cause an increase anxiety for elder patients. Couple this "normal response" to hospitalization with any amount of cognitive and/or physical impairment, and the anxiety increases and, subsequently, the ability to participate in care decreases. Having a trusted family member or friend at their side can assist in decreasing anxiety and increasing their feeling of safety, inclusion, and provide better outcomes.

The CARE Act creates the opportunity for family caregivers to be more involved in the healthcare process, to have a voice beyond the watchful eye for safety and ultimately, to be part of the team! These programs, along with open records, bedside shift report, and patient directed visitation will not only improve the experience but will also improve the outcomes for patients.

The staggering differences in Hospital Charges

In a report recently released by the Centers for Medicare and Medicaid, the cost in 2013 of many hospital procedures was made public. Chock rich in data, the report can be accessed at the CMS website. While the charges are not the same as what Medicare and insurers actually pay, it is important to note that both vary from one hospital to another - sometimes within a relatively close distance.

The differences can particularly impact people with high deductible plans, those without coverage for certain services and those using out of network providers. The CT Mirror recently analyzed the information in their report, 10 procedures for which CT hospital charges vary most, specifically sharing the Connecticut findings and well worth reading. They highlighted the varying cost of a spinal fusion, which ranged from $21,945 to $158,360, an eight-fold difference! For readers outside of Connecticut, the inpatient charge data can be downloaded here and can be sorted by zip code to localize it.

For our readers who are interested in better understanding their healthcare data in general, Consumer Reports has released, "Your Medical Data What You Need to Know Now."

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