September 9, 2016
The Power of Apology
In fiscal year 2015, there were 221 serious medical errors affecting 252 patients reported by Maryland's hospitals to the state Office of Health Care Quality. Since official reporting began in 2004, there have been 2,472 Level 1 adverse events, defined as those that cause death or serious injury. That's nearly 2,500 reasons why hospitals are always working to improve quality and patient safety.
 
But the way we handle each of these types of events says a lot about us. By focusing as much as possible on transparency when medical errors occur, instead of the traditional defensive stance, we can stave off the resulting separation and detachment among patients, families and caregivers. It's not easy in this litigious society, but it can be done. And CANDOR can help.
 
CANDOR is short for "Communication and Optimal Resolution," a program developed by the Agency for Healthcare Research and Quality that helps break down the walls that tend to get built when an error occurs. At its core, CANDOR encourages full disclosure and an apology following an adverse event. Not only has this been shown to save hospitals money, but it also fosters patient involvement in quality improvement processes and post-incident analyses. And, more importantly, it's simply the right thing to do for someone who has been harmed.
 
Next month, Maryland's hospital leaders will have the opportunity to learn more about CANDOR from the MedStar Institute for Quality & Safety and the Collaborative for Improvement and Accountability, The institute is convening an interactive training for leaders, Taking Action with CANDOR, on October 20 and 21 at the Omni Shoreham in Washington, D.C. Eight of MedStar Health's hospitals participated in a pilot program for CANDOR and in the past four years, MedStar has lowered serious safety events by almost 60 percent. They attribute some of that improvement to CANDOR.
 
The small-group training (attendees are eligible for continuing education credits), designed for board members, CEOs, COOs, CMOs, CNOs, and other patient safety leaders, will focus on the CANDOR toolkit, which contains videos, PowerPoint presentations and other documents explaining a variety of activities, including how to hold conversations with patients and families and how to implement disclosure programs across an institution.
 
MHA is an event partner and members of MHA are entitled to discounted rates (discount code is "NO HARM"). Click here for more information and here to register. Hope to see you there.
Resources Available on Nondiscrimination Disclosures
Following the May release of a final ruling from the U.S. Department of Health & Human Services Office for Civil Rights (OCR) on Section 1557 of the Affordable Care Act, some MHA members have inquired about the provision regarding nondiscrimination disclosures. HHS offers a FAQ on the ruling, and the Washington State Hospital Association has compiled a comprehensive summary of the requirements for hospitals. Here are the key points regarding the notification provisions of Section 1557, which apply to hospitals as well as covered entities that receive federal financial assistance from HHS, and which are effective October 16: 
  • Hospitals must post non-discrimination statements in a "conspicuously-visible font size" and in "conspicuous locations" where there is interaction with the public and are encouraged to post in additional languages besides English. The final rule has a template of what should be posted, but hospitals can craft their own as long as it meets all the elements of the rule. 
  • Hospitals must post "taglines" in the top 15 languages spoken in the state alongside the non-discrimination notice. These "taglines" tell patients with limited English that translation assistance is available for them. The top 15 languages in Maryland, according to the U.S. Census, are: English, Spanish, French, Chinese, Korean, Ibo/Yoruba, Tagalog, Russian, Vietnamese, Amharic, German, Urdu, Hindi, Arabic, and Farsi. Sample statements of nondiscrimination and sample taglines are available through the OCR.
  • Hospitals have to include both these elements (the non-discrimination statement in English and taglines in 15 languages) on their website in a link that is conspicuously placed on the homepage and immediately takes people to these statements.
  • Hospitals have to include both these elements in "significant publications or significant communications targeted to beneficiaries, enrollees, applicants, or members of the public, which may include patient handbooks, outreach publications, or written notices pertaining to rights or benefits or requiring a response from an individual."
  • Hospitals are allowed to deplete their current stock of materials before printing new materials with these required elements.
  • Hospitals can use shortened versions of the non-discrimination statement and include only two taglines for "small-size significant publications and significant communication" (e.g. marketing tri-folds).
 
Contact: Nora Hoban
Register for Webinars on CMS Data Use Agreement
MHA and CRISP invite you to attend one of two webinars to learn how CMS will make available Medicare data so that hospitals can better understand trends and manage total cost of care growth. The webinars will be September 13 and 21 - each will cover the same material so you will only need to register for one. 
Statewide Meeting on Behavioral Health Scheduled
Behavioral health needs in Maryland have reached a crisis level and every aspect of our health care system is strained because of these unmet needs. Now is the time for hospitals and community behavioral health providers to come together to help all Marylanders. MHA is partnering with several community behavioral health providers on a Behavioral Health Statewide Meeting October 11 at the BWI Marriott. The meeting will convene hospital discharge planners, emergency department staff, community-based behavioral health providers, and local health departments to:
  • highlight successful and effective partnerships between hospitals and community behavioral health providers
  • discuss issues and challenges to collaboration
  • share data and discuss actionable opportunities for strategic partnership
  • network and build foundation for strategic alignment
There is no charge to attend, but you must RSVP here. Registration is limited to two people from each organization. If you have any questions, contact Sheena Siddiqui.
Materials Available for All-Payer Advisory Council Meeting
The Health Services Cost Review Commission's All-Payer Hospital System Modernization Advisory Council meets Monday, September 12. Materials for the meeting are posted on HSCRC's website (scroll down to the September 12 meeting). 
CMS Modifies Accountable Health Communities Funding Opportunity
The Centers for Medicare & Medicaid Services (CMS) is changing its Funding Opportunity Announcement for Track 1 of the Accountable Health Communities (AHC) Model, with two modifications to make the model more accessible to a broader set of applicants: 
  1. The annual number of beneficiaries that applicants are required to screen will be reduced from 75,000 to 53,000
  2. The maximum funding amount per award recipient will be increased from $1 million to $1.17 million over five years
 
The AHC model focuses on the health-related social needs of Medicare and Medicaid beneficiaries, such as housing instability, hunger, and interpersonal violence. The model is based on evidence that addressing health-related social needs through enhanced clinical-community partnerships can improve health outcomes and reduce costs. Track 1 supports organizations working to increase a patient's awareness of available community services through screening, information dissemination, and referral. Track 1 award recipients will partner with the state Medicaid agency, community service providers and clinical delivery sites to implement the model. More information about the announcement and the application process is available here. Questions about the AHC Model can be sent to AccountableHealthCommunities@cms.hhs.gov.
Modern Healthcare Launches Transformation Hub
Modern Healthcare has launched a new section of its website; the Transformation Hub. The special news and information section will be used to tell the stories of health system transformation going on across the country. It will focus on the innovations and innovator firms inside delivery organizations, and success stories from firms all over the country that are providing new information technology to aid health systems with their transformation. If you have an improvement story to tell, send a note to Gregg Blesch, Managing Editor.
Adding Value to Physician Practices
 
Every MHEI hospital member has physician practices associated with your hospital. With population health as a focus and the current approach to hospital operations, we are watching hospitals as they work to forge better and closer relationships with these provider practices.

Looking for a Leading Provider for Blood and Associated Services?
 
For more than 60 years, Blood Bank of Delmarva (BBD) has provided blood and blood components to hospitals throughout the Delmarva region, helping avoid blood shortages and saving thousands of lives with assistance from more than 150,000 current donors.

CMS Releases Final Emergency Preparedness Rule for Hospitals
 
The Centers for Medicare & Medicaid Services on Thursday released a final rule bolstering emergency preparedness requirements for hospitals and other critical facilities.

THE WEEK AHEAD
Tuesday, September 13
- MHA to present an update on the Maryland All-Payer Model for the House of Delegates
  Health and Government Operations Committee

Wednesday, September 14
- Health Services Cost Review Commission meeting

Thursday, September 15
- MHA Financial Technical Work Group meeting
TOP NEWS FROM THE WEEK
Delmarva Now, By Jeremy Cox, September 2
 
The Baltimore Sun, By Meredith Cohn, September 3
 
The Baltimore Sun, By Meredith Cohn, September 2
 
The Baltimore Sun, By Andrea K. McDaniels, September 6
 
The Baltimore Sun, By Andrea K. McDaniels, September 6
 
Baltimore Business Journal, By Vandana Sinha, September 7
 
The Baltimore Sun, By Andrea K. McDaniels, September 9
 
The Baltimore Sun, By Erin Cox, September 9