CT Center for Patient Safety
CT Center for Patient Safety Newsletter

August 2015
In This Issue

August Health Hint

 Vacations and Your Health Insurance


During summer, many people take vacations abroad and often travelers are unaware that their healthcare insurance coverage may or may not cover them and, if it does, how it will work. With all of the changes brought about as a result of health insurance reform, it is important to ask questions of your carrier.


UStiA, the United States Travel Insurance Association conducted a survey and concluded that "traditional domestic health insurance plans typically limit coverage for out-of-country medical expenses to emergency-related costs; have high deductibles and co-pays for emergency treatment abroad; and don't necessarily cover out-of-country emergency medical transportation in cases of life threatening illness where medical evacuation may be required." It is important to know that Medicare does not usually provide coverage for people who are traveling outside the U.S. and its territories.  For people whose coverage will not be adequate in an emergency, stand-alone travel insurance can often be purchased.


Does this Proposed new Healthcare Law Hurt or Help Patients?



Guest Contributors: Diana Zuckerman, PhD, President and Paul Brown, Government Relations Manager  |  National Center for Health Research.  The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that promotes the health and safety of adults and children.  http://center4research.org/


Patients have been actively lobbying for and against the 21st Century Cures Act.  There is a great deal of passion on both sides of the issue.  Here is what you need to know as you consider whether to contact your U.S. Senators about this bill.  

The Act passed the U.S. House of Representatives in July.  There was a lot of praise from patient organizations, well-known charities, and universities.  They were excited about the increase in funding for the NIH and optimistic that the bill would provide the cures to desperate patients.  

But at the same time that supporters claim the bill would save lives, other patient and consumer advocates point out that it would drastically lower FDA standards for new medical products.  That would make it easier for drug and medical device companies to sell more of their products more quickly, but unfortunately, many of those products will not be cures, or even be beneficial to patients.  Instead of moving us into the 21st century, many of us think the bill moves us back to the days before the tragedies from Thalidomide, DES, and the Dalkon Shield IUD resulted in FDA laws requiring scientific standards to protect patients from unsafe medical products.


Speed vs. Careful Review at the FDA.  The House's 21st Century Cures Act encourages the FDA to lower its standards so that companies can sell new drugs and devices to patients based on very preliminary evidence, such as rat studies and subjective information about just a few patients -including "case histories" of just one patient.  That would take us back to the early 20th century, to an era of snake oil salesmen.

The 21st Century Cures Act would also take away FDA's authority to make sure medical software is accurate.  Innovative technology such as interactive electronic medical records can remind doctors about drug interactions and other dangers.  People's lives can depend on that software -- which tells patients or their doctors what tests a patient needs, whether they need more insulin immediately, etc.  It needs to be regulated by FDA to make sure it is accurate.  The House bill eliminates the FDA's authority to regulate most electronic software.  The Senate should not allow that to happen.


The House bill would allow companies to give doctors expensive gifts and travel funds without making those gifts public.  This rips a hole in the Physician Sunshine Act that the House and Senate previously supported.   The Senate should not allow it.


The House bill would allow companies that make potentially life-saving devices to make changes to the design or materials used without submitting them to the FDA for approval.Companies would just have to prove to a third party (paid for by the company itself) that they have good quality control mechanisms in place.   This concerns those of us who have seen how employees of even the best companies can overlook safety concerns when the bottom line is at stake.


This House bill would worsen antibiotic resistance. One section of the bill "encourages the development and use of new antimicrobial drugs." Unfortunately, the bill encourages the overuse of poorly tested new antibiotics, which means that bacteria would soon develop resistance to them.


We all want cures and we know that Congressional cuts in NIH funding have harmed medical research.  But Members of Congress need their constituents to remind them that FDA safeguards save lives every day.  A law that would enable unsafe drugs and devices to get FDA approval and be sold to unsuspecting patients is a very dangerous drug.   And we would all pay for it, when taxpayers support Medicare, Medicaid, and Veterans' healthcare, and when individuals pay for medical treatment and for health insurance.  

Two Patient Tools for Evaluating Hospitals and Surgeons


Recently, ProPublica published a new tool called the Surgeon Scorecard to provide patients with newly available information in a useful format to help to evaluate surgeons.  The data reflects their calculations of death and complication rates for 17,000 surgeons who performed one of eight "low risk" elective procedures.  The data, culled from Medicare records and adjusted for patient's health, age and hospital quality, resulting in a database that gives patients some very helpful information.  It also allows surgeons to see how their results compare to those of their peers.  Interestingly, one thing that was found was that only 11 percent of the doctors accounted for about 25 percent of the complications.  Through the tool, readers can look up surgeons by their location, a specific hospital or by the surgeon's name.  This will allow comparisons between surgeons who do the same procedure within a hospital or within a local.  The story behind the data, the methodology used and the feedback that the authors of the study are receiving can be found here as well.


Also, last week, Medicare released their updated version of their Hospital Compare tool.  While a version of this tool has been available for some time, using outcomes for patients admitted to the hospital for seven medical conditions, CMS tracked patient outcomes such as death, unplanned readmissions and complications and present them to users in a very consumer friendly, informative way.  After you enter your zip code, you can select up to three hospitals to compare side-by-side as well as to each other and to the national average using charts and graphs. 

We always recommend that patients use multiple tools when making decisions related to care, and to understand what is being measured or evaluated in each tool.  As more data becomes available, the value of these tools will improve even more and patients will be able to be better informed and more engaged in their own care.

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Dear Members, 


Summer is well underway, the impact of the "July Effect" (the start of new residencies in our hospitals) is winding down and people are beginning to think about another school year that is almost upon us. In spite of all of the challenges facing our healthcare system there are good healthcare stories to share! I recently read about an eight year old Baltimore boy who received the first double hand transplant. He has an amazing spirit and wisdom beyond his years. Technology and advances in medicine made this possible. Technology is also allowing us to bring people together in many different ways. The Connecticut Center for Patient Safety has an active Facebook page where we share news stories, events and our thoughts on healthcare related topics. Please join the conversation and feel free to share your thoughts and responses to our postings. Our website is regularly updated with links to resources and relevant news stories.


Realizing that this is a time of change, and change can be very unsettling for many, we are working to keep the focus on what matters to patients: safe, high quality care. As we enter a new fiscal year, we continue our work educating consumers, policy makers and providers of healthcare through the patient perspective. Through patient stories, a curriculum that focuses on person-centered, high quality, safe health care for all consumers, as well as other efforts, we are working to change the culture of care. Our participation in various projects throughout the state, including those supporting patient and family advisory councils in our hospitals, health care literacy efforts in our communities, and transparency of information on infections, physicians and hospitals continue.

We always welcome your thoughts, ideas and perspective.


Please become involved by posting to our Facebook page or through our website.


Lisa Freeman 

What is Written in the Stars?

 Advancing Safety for Elders


Guest contributor: Jim Kinsey, Director Planetree Member Experience


There are a variety of consumer tools available for assisting families with choosing a nursing home. None are more popular than the Nursing Home Compare section of the medicare.gov website.  This site offers a full search and the ability to compare nursing homes on your area against others.  The site contains publically reported data that is presented in an effort to aid families in their decision.  The indicators posted include: health and safety inspections, staffing, penalties and quality indicators; all-important relevant information to contribute to the decision making process, but what is missing? What should be added to make an informed decision?


The indicators that are public focus on quality of care and available staffing, but they do not demonstrate what quality of life is for elders residing in the community.  While care is, and should be, the forefront of a decision, quality

of life should be equal to care as consumers are selecting a community where their loved one is going to reside.

Compounding the issue of identifying quality of life indicators is a time frame that is often limited for making a selection and is usually occurring in the middle of a health crisis.  So, what is a family to do? How can they be sure of their decision?


First, start as soon as possible.  If your loved one is hospitalized, advocate for discharge planning from the very beginning, from the first day.  Admittedly, this is a time of crisis for many, but having the discussions early on will allow for a more comprehensive decision making process for the family.  Next, fan out!  Determine the capture area and the communities you want to visit, using Nursing Home Compare to strategize your visits based on quality of care.  Create a list of questions and observations you would like to make during each visit and involve, as possible, sharing the responsibility with other family members-create a team approach. 


When creating the list for your visit, consider including the following:

  • Ask for an opportunity to talk with a resident that is living in the community.  Also, ask for an opportunity to talk with a family member and/or a staff member while you are there.  These individuals may be able to provide insights to how it is to experience and provide care in the community.  Advocate for these discussions to be private and not include the staff member assisting with the tour.
  • Interview the administrator. Ask what the community's philosophy of care is. Is there a focus on resident-centered care? How does the community support self-determination and honoring individual choice? 
  • Observe for indicators of engagement. Are people cheerful? Do they say, "Hello?" If possible, ask to observe an activity program and observe to see if residents are engaged or if they are passively participating.
  • Participate in a meal. What is the experience like? Is there music or conversation? Is it calm and soothing?  Are napkins and china being used, or are there childlike bibs in use and plastic ware? 
  • During the tour, observe to see what residents that may not have full cognitive ability are doing. Is there evidence of boredom? Is there evidence of loneliness?
  • Finally, how is the environment?  What is the temperature and color? Is there a presence of an odor?  Are hallways clear of clutter, making it easy for residents to move through the community?  Is there pleasant sound or more medicalized or intrusive sounds present? 

There are many other indicators of positive quality of life: resident involvement in planning, number of opportunities to take trips out of the community, and the ability to control one's day.  Combining the importance of quality of life with quality of care is a balanced approach to making a very difficult decision.


by Michael Elizondo


There is nothing 

funny about being sick, or is there? The answer is yes and no. Surely, it's no fun having an illness, but it can be far more bearable when viewed from a humorous perspective. In fact, many professional comedians have taken real life tragedies and turned them into comedy gold. Richard Prior's bit about experiencing a heart attack is one of the funniest I've ever heard. Louie Anderson tells of growing up with an alcoholic father and he brings down the house. Robert Schimmel's routine on surviving cancer has been called "simply hilarious."

Clearly, there is something about surviving adversity and illness that tickles our funny bone. I believe it was Woody Allen who said, "tragedy plus time equals comedy". The key word here is time. Once you've put some distance between you and your diagnosis, you can view it not as a tragedy, but as a learning, humbling, and yes...humorous experience.


Still not convinced? I felt the same way when I was first diagnosed with Nephrotic Syndrome back in June of 1989. Nephrotic Syndrome is a type of kidney ailment, categorized as an autoimmune disease, in which damage to the capillaries of the glomeruli (microscopic blood vessels in the kidneys) cause the protein albumin to leak into the urine. If the leakage of fluid from blood vessels into tissues depletes the liquid component of blood and the blood supply to the kidney is diminished, there is a considerable risk of kidney failure. This proposition made me cry, not because of the fear of possible kidney failure, or the uncertainty of living with kidney disease, but because the biopsy hurt like a SOB.


The fact that my procedure was done at County USC Medical Center in Los Angeles made it all the more terrifying. The place was scary. I walked in and saw a guy on a ventilator handcuffed to his own gurney...obviously a flight risk. I don't want to say the hospital was a dangerous place, but when I was admitted, they didn't give me a gown, they gave me a bulletproof vest..., that opened in the back... for easy access.


These are just a couple of real life examples of how humor can be found in even the most challenging of circumstances. The point is, the sooner you can find the funny in your own crisis, the sooner you can experience the medicinal value and healing power of humor. It's been said that laughter is the best medicine. For me, it's been an integral part of the healing process. Sharing this insight and making people laugh is the reason I give humorous presentations. The key is not to take life so seriously. Give yourself permission to laugh and it will pay off in droves. Remember, there is something funny that can be found in illness; all you have to do is allow yourself some time, and be willing to laugh.


Courtesy of the American Association for Therapeutic Humor