HEALTHCARE IN THE USA: WHAT CLINICIANS NEED TO KNOW!

HEALTHCARE IN THE USA:

WHAT CLINICIANS NEED TO KNOW!

Russ Nassof, Esq

Russell Nassof is a paid consultant of Ethicon US, LLC.

This promotional educational activity is brought to you by Ethicon US, LLC.

Healthcare Wheel of Fortune

Program

• The Business of Medicine

• Background

• Solution

• Affordable Care Act (ACA)

• Problems

• Why Should We Care?

• The Legal Stuff

• Importance of Product Selection

• Liability Minimization

The Business of Medicine


• DO NO HARM (Clinician) versus

• MAKE $$$$ (Lawyers)


All too often… Brings the Bad News!


All too often… Never Invited to Lunch!


All too often… Invited AFTER the Adverse Event


All too often… How We Feel At the End of the Day!


The Solution:


Creating an Accountable Care Org. (ACO)

Personnel Shortages

Technology

Population Health Management

Physician-Hospital Relations

PATIENT SATISFACTION

Care for the uninsured

PATIENT SAFETY AND QUALITY

GOVERNMENT MANDATES

HEALTHCARE REFORM IMPLEMENTATION

FINANCIAL CHALLENGES*

*http://www.ache.org/pubs/research/ceoissues.cfm. Accessed 2/18/16

Where did This Come From???

Pronovost and Prevention

The Problem with Zero

• Umschied – ”As many as 33% of all cases of CLABSI and almost 50% of SSI and VAP were not preventable.”*

What is Preventable = Moving Target

• When Nothing was Preventable there was No Liability• *Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating

the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011 Feb;32(2):101-14.

• *Umac

Preventability and Liability

Why?

The Background

The More That is

Preventable…

The more we have to report to

regulators;

The more potential liability

may be imposed.

The more insurance

companies do not have to pay; and,

And Today- even adverse

events such as falls are

deemed to be preventable

and the list grows every

year…

The Problem

• Regulating Healthcare vs Clinical Practice?

The Solution?

• Fee for Service vs. Pay for Performance

• 2001- NQF and the “Never Events”-29 events

• Terminology is problematic but caught on with payors, regulators, PSOs,

state health organizations, etc.

• Serious, largely preventable patient safety incidents that should not occur

with appropriate preventive measures (includes contaminated device

injury/illness/death)

• List has grown slowly from inception

The Solution?


• 2008- Center for Medicare/Medicaid Services (CMS)- “To encourage

hospitals to prevent certain HACs not POA.”*

• Deficit Reduction Act (DRA)- Hospitals will no longer receive the

differential (enhanced payment) when the sole reason for the

differential was REASONABLY PREVENTABLE through adherence to

evidence based guidelines.*

• POA conditions become critical

• 11 conditions included (some overlap with NQF “Never Events” list)

• Includes Vascular Catheter-associated Infections, catheter-associated

urinary tract infections, falls, and pressure ulcers (stages III and IV)**

*https://www.fojp.com/sites/default/files/infocusFall10.pdf. Accessed 2/20/16

**https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/hospital-acquired_conditions.html. Accessed

2/20/16

The Solution?

The ACA• Fee for Service vs. Pay for Performance

• 2010- Patient Protection and Affordable Care Act(ACA)-ObamaCare

• 16.4 million newly insured with 8 million enrolled in a marketplace plan*

• Uninsured fell from 18% to 9.2% as of 8/15**

• Financial rewards/penalties based on quality measure attainment

established by CMS (including HAIs)

• New Goal- 30% of direct payments to doctors, hospitals, and other

providers will be through alternative payment models

*http://www.hhs.gov/healthcare/fact-and-features/fact-sheets/aca-is-working/index.html. Accessed 2/20/16

**http://www.dailykos.com/story/2015/11/5/1445323/-CDC-Uninsured-rate-lowest-ever. Accessed 2/20/16

The ACA


More changes to CMS payments

I. Hospital Readmissions Reduction Program

II. Hospital Acquired Conditions (HACs)

III. Hospital Value Based Purchasing

IV. Hospital Inpatient Quality Reporting Program

ALL 4 PROGRAMS WORK IN TANDEM TO INCENTIVIZE

IMPROVED PATIENT OUTCOMES/SATISFACTION WITH

LOWER COST

The ACA

• Why Should We Care about the ACA?

• Focus on improving patient outcomes

• Improved outcomes will result from reduction in vascular catheter

related adverse events

• Reduction in vascular catheter adverse events will result from

selection of the right product for the right patient at the right time

• Government will penalize those failing to achieve improved

outcomes and will reward those that are successful

• Bottom Line- INCREASED SCRUTINY OF VASCULAR CLINICIAN

PRACTICE

The ACA

• Changes to CMS

I. Hospital Readmission Reduction Program

• Penalties (3% in 2015) on hospitals that have excess readmissions

(above the national average) for

• Cardiac- AMI/Heart Failure

• Pulmonary-Pneumonia/COPD

• Orthopedic-Total Hip/Knee Arthroplasty

• Potential for more to be added-CABG/percutaneous coronary intervention

• Some allowances now made for demographics, comorbidities, patient

frailties (risk adjustment)*

* The Advisory Board Company, Healthcare Industry Committee, Hospital Readmissions Reduction Program, C-Suite Cheat Sheet Series, August 2013.

Accessed 2/21/16

The ACA

• Changes to CMS

II. Hospital Acquired Conditions

• Penalties (1%) on hospitals in the top 25% for the following HACs

(among others)

• CENTRAL VENOUS CATHETER BLOODSTREAM INFECTIONS

• Pressure ulcer rate

• Postop. hip fracture rate

• Postop. sepsis rate

• Postop. pulmonary embolism or DVT

• Catheter-associated urinary tract infection (CAUTI)

• C.difficile/MRSA/SSIs of colon, abdomen coming in ‘16/’17*

*The Advisory Board Company, Healthcare Industry Committee. Hospital-Acquired Condition Reduction Program. C-Suite Cheat Series. August 2013. Accessed 2/21/16.

The Affordable Care Act

Hospital Acquired Condition (HAC) Program

Domain 1(AHRQ Measure)

AHRQ Patient Safety

Indicators PSI-90 Composite

This measure consists of:PSI-3: pressure ulcer

PSI-6: iatrogenic pneumothorax

PSI-7: central venous catheter-related

blood stream infection rate

PSI-8: hip fracture rate

PSI-12: postoperative PE/DVT rate

PSI-13: sepsis rate

PSI-14: wound dehiscence rate

PSI-15: accidental puncture

Weighted 25%

Domain 2(CDC Measure)

Weighted 75%

2015 (measures):CLABSI

CAUTI

2016Surgical Site Infection (Colon Surgery

and Abdominal Hysterectomy)

2017 (2 additional measures):MRSA

C Diff

Performance Period July 1, 2012 – June 30, 2014 Performance Period January 1, 2013 – December 31, 2014

100%

Association of American Medical Colleges presentation. https://s3.amazonnaws.com/public-inspection, federalregister.gov/2013-18956. Accessed 2/20/16.

www.stratishealth.org/documents/HAC_fact_sheet.pdf. Accessed 2/20/16

https://s3.amazonnaws.com/public-inspection

http://www.stratishealth.org/documents/HAC_fact_sheet.pdf

The ACA

• Changes to CMS

III. Value Based Purchasing (VBP)

• The Name…DOES NOT SAY IT ALL

• Penalties- Up to 2%

• Incentives- Up to 2%

• Budget Neutral for CMS- Hospitals pay on the front end and then

either receive the $$ back, lose the $$, or receive a bonus $$

based upon a Total Performance Score (TPS)*

* http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-

purchasing/index.html?redirect=/hospital-value-based-purchasing/. Accessed 2/20/16

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/hospital-value-based-purchasing/

The ACA• Value Based Purchasing

Improvement (self)

Hospitals will be assessed on how much their current

performance changes from their own baseline period

performance

Achievement (others)

Hospitals measured based on how much their current

performance differs from all other hospitals’ baseline

period performance

Total

Performance

Score (TPS)vs

vs

*http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/hospital-value-based-

purchasing/. Accessed 2/21/16

The ACA

• Changes to CMS

IV. Value Based Purchasing (VBP)

• Domains/Scoring (‘13) 2017

• Clinical Process- 70% 5%

• Patient Satisfaction- 30% 25%

• Outcomes -0% 25%

• Safety-CLABSI- 0% 20%

• Efficiency-0% 25%*

*http://www.stratishealth.org/documents/FY2017-VBP-fact-sheet.pdf. Accessed 2/19/16

*https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets-items/2015-10-26.html Accessed 2/19/16

Percent of CMS Dollars at Stake by FY

2017

Value Based

Purchasing+/

-2%

Readmission

Reduction

Program

3%

Healthcare Acquired

Condition Program

1%plus any

deductions

under the

deficit

reduction act

and other

regulations*

*The Advisory Board Company, Healthcare Industry Committee, Hospital Value-Based Purchasing. C-Suite Cheat Sheet Series. August 2013.-accessed 2/20/16

**The Advisory Board Company, Healthcare Industry Committee, Hospital Readmissions Reduction Program. C- Suite Cheat Sheet Series. August 2013.- accessed 2/20/16

***The Advisory Board Company, Healthcare Industry Committee, Hospital-Acquired Condition Reduction Program. C-Suite Cheat Sheet Series. August 2013. Accessed

2/20/16

The ACA

• So what does 6% amount to anyway???

• Readmissions- $161,240 (average penalty ‘15)

• VBP- $91,873 (average penalty ‘15)

• HACs- $541,896 (average penalty ’15)

• Total = $795,009 (average penalty ‘15)

• But if you were a poor performer the total could be as high as

$8,570,333 !!!!!!!!!!(2015)*

*https://www.ahd.com/state.html. Accessed 2/21/16

The Advisory Board Pay for Performance File-https://www.advisory.com/research/health-care-industry-committee/members/resources/2014/p4p-impact-file.

Accessed 2/21/16

The ACA• More Changes to CMS

• Hospital Inpatient Quality Reporting Program

• Financial incentive (up to 2%) for reporting quality of services so as to provide consumers with data to make more informed decisions re care (Hospital Compare)*

• HAC Reduction Program results available on Hospital Compare

• Includes HAIs- CLABSI, CAUTI, SSIs, MRSA, C.diff as well as other adverse events**

• Uses CDC NHSN definitions and provides hospitals with tools to perform self-assessments

• As of 1/1/15 CLABSI/CAUTI reporting includes ALL medical and surgical beds-not JUST ICUs.

*https://www/cms/gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/hospitalrhqdapu.html. Accessed 2/18/16

** http://www.qualityreportingcenter.com/wp-content/uploads/2015/01/IQR_FY-2016-Reference-Checklist.pdf. Accessed 2/18/16

http://www.qualityreportingcenter.com/wp-content/uploads/2015/01/IQR_FY-2016-Reference-Checklist.pdf

The ACA

• Health Information Technology for Economic and Clinical

Health (HITECH)-2009

• HITECH is a separate act with funding to enhance the widespread

adoption of electronic health record (EHR) usage*

• Adoption will assist in facilitating compliance with regulatory/data

reporting requirements for adverse events

• Advantages but many risks…

*https://www.healthit.gov/policy-researchers-implementers/health-it-legislation. Accessed 2.22.16

• CMS readmission

penalties3

• Non payment of

Healthcare Acquired

Conditions (HACs)1

• Value-based

purchasing2

• Reportable quality

metrics 2,3,4

• Measured patient

outcomes 2,4

• Patient satisfaction

reporting 2,4

Affordable Care

Act

Regulatory

Requirements

Provider Opportunities

in Changing Landscape

• Reduce Readmissions

• Reduce HAIs

• Improve Patient Satisfaction

• Improve Patient Outcomes

• Use Evidence Based Medicine/Practice

1 – Medicare Program: Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership

in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding

Financial Relationship Between Hospitals; Final Rule, Federal Register, Volume 73, Number 161, Tuesday, August, 19, 2008. Accessed October 7, 2014

2 – Medicare Program: Hospital Inpatient Value-Based Purchasing Program, Federal Register, Volume 76, Number 88, Friday, May 6, 2011. Accessed October 7, 2014

3 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY2012 Rates; Hospitals’ FTE Resident Caps for Graduate Medical

Education Payment, Federal Register, Volume 76, Number 160, Thursday, August 18, 2011. Accessed October 7, 2014

4 – Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Federal Register, Volume 76, Number 212, Wednesday, November, 2, 2011. Accessed October 7, 2014

5 - https://innovation.cms.gov/initiatives/bundled-payments/ Accessed 11/5/15

Goals

https://innovation.cms.gov/initiatives/bundled-payments/

More Problems…

Non-clinicians who

know nothing about

infection prevention

have assumed that

all infections must be

preventable and are

somehow the result

of a lapse in patient

care.

“The patient in the next bed is highly

infectious. Thank God for these curtains.”

More Problems…

• Are these preventable HAI sources?

• Overpopulation of hospitals

• Multi-drug resistance

• Visitor hygiene/illnesses

• Patients own immune system condition

• Physical proximity of patients

• Increasingly invasive procedures

• Use of antibiotics

• Endogenous infections

• Multiplicity of HAI origins today often makes it difficult to identify precise HAI source!

More Problems…

Contaminated environment –source of many pathogens “facilities

are dirty” BUT

Evidence lacking – difficult to precisely link infection with exact

environmental source and transmission event ..however

Data on Outbreaks – Successful interruption after interventions

eliminating potential environmental sources

The Problem of

HAI Sources

More Problems…

NHSN HAI Definitions

More Problems…

Healthcare-associated Infection

(HAI)

Must be contracted in healthcare

setting*

Must not be present on admission

(POA)*

POA-2 days prior/2 days

after…*OR REBUTTABLE

PRESUMPTION?

*http://www.cdc.gov/nhsn/pdf/pscmanual/protocol-clarification.pdf. Accessed 2/22/16

More Problems…

BUT…

Many infections are asymptomatic after onset for some time*

Colonization/inflammation are not infections*

Extensions of infections which are POA are not HAI unless there is a

change of pathogens but this is not applicable to SSIs, VAEs*

What about device removal/reinsertion?

No consensus on optimal time point for PVC change or if required at all

CLABSI- just need a central line and the NHSN definition- no need to

prove a source of infection*

PVC infection rate- likely vastly underreported

*http://leg5.state.va.us/reg_agent/frmView.aspx?Viewid=32b11002109~3&typ=40&actno=002109&mime=application/pdf. Accessed 2/20/16

More Problems…

• Does anyone other than Chellie DeVries care about

Peripheral Lines?

• 300 million sold/year

• Up to 90% of patients have a PIV

• Up to 50% failure rate

• PVC infection rate-incidence (up to 2.2%) is low but the numbers

are HUGE

• Are PVC infections less problematic than CLABSIs?

The catheter may be different but the pathogens and pathways are the

SAME*

*Helm R. Klausner K. Klemperer,J. Flint L, Huang E. Accepted but Unacceptable: Peripheral IV Catheter

Failure, The Art and Science of Infusion Nursing;2015:189-203.

Why Should We Care?

• Vascular Clinicians

• Focus of ACA on vascular issues without regard to type/location of

catheter

• Penalties/Incentives for vascular catheter-related events

• Increased scrutiny on reporting, adverse event occurrence,

improvement, patient satisfaction and outcome

• Product selection could have great impact on outcomes

Why Should We Care?

• Vascular Clinicians

• More patients… but not more staff

• More responsibility…but not more $$$

• More documentation…but no more time

• More liability…

• Failure to protect patient from avoidable injury

• Failure to prevent infection

• Failure to monitor and assess clinical status

• Failure to use equipment properly*

*Diehl-Svrjcek B. Dawson B., Duncan L. Infusion Nursing-Aspects of Practice Liability. Journal of Infusion

Nursing, 2007: vol. 30, no 5;274-79.

Why Should We Care?

Providers/Physicians/Nurses

Can always be sued- regardless of merit- and will need to

defend and under strict liability can be liable without fault

and without negligence

Consider having your own Professional Legal Liability

(PLL) insurance:

“Free Nursing Input”- can lead to lawsuits

Good Samaritan Law immunity does not prevent lawsuit filing

Some states permit hospital indemnification for nurse

acts/omissions

Inexpensive

Why Should We Care?

And the big news is that nurses are STRESSED

OUT-Nursing Times

46% worked longer hours than last year

80% reported short staffing at least weekly

73% suffered work related stress-physical, mental problems

37% took more sick leave

74% felt pressure to come to work sick

2x the depression rate of general population

http://www/fiercehealthcare.com/story/survey-nurses-overworked-understaffed-and-stressed/2013-10-01. Accessed 5/5/15

http://www/fiercehealthcare.com/story/survey-nurses-overworked-understaffed-and-stressed/2013-10-01

The Legal Stuff

Medical Malpractice occurs when…

http://www.pintas.com/medical-malpractice.html. Accessed 2/2016

http://www.pintas.com/medical-malpractice.html

The Legal Stuff

Negligence:

Duty- legal duty to exercise

reasonable care

Breach- failure to exercise

reasonable care

Causation- physical harm caused

by the conduct

Damage- physical harm/actual

damages

The Legal Stuff

The Standard of Care…

YOU ARE ALLOWED TO BE WRONG!

YOU ARE ALLOWED TO MAKE MISTAKES!

YOU ARE NOT ALLOWED TO BE NEGLIGENT!!!http://www.west.net/~smith/negligence.htm.

Accessed 2/20/16

http://www.west.net/~smith/negligence.htm

The Legal Stuff

• Standard of Care (SOC)

• Experts frequently have different opinions as what constitutes the

SOC

• Nursing has always been based on some sort of evidence

• SOC IS RARELY 100% EVIDENCED BASED but the more

evidence based the stronger the standard

The Legal Stuff

• What is Evidence Based Medicine (EBM) or Evidence

Based Practice (EBP)?

• Problem solving approach to clinical decision making within a

healthcare organization integrating best available scientific and

experiential evidence. (Science & Experience)*

*http://www.hopkinsmedicine.org/gim/research/method/ebm.html. Accessed 2/20/16

The Legal Stuff

• What is the importance of EBM and EBP?

• Will NOT prevent you from getting sued… BUT

• Should improve the quality of care provided and

• Should decrease your chances of litigation*

*http://www.ampirrg.com/articles/Evidence-based_medicine.pdf.

Accessed 2/20/16

The Legal Stuff

• How does PRODUCT SELECTION fit in with EBM and

EBP?

• Utilizing products that are Evidenced Based:

• Proven and tested;

• Should reduce adverse events and improve patient outcomes;

• Should reduce variation across the continuum of care

• Should reduce medical malpractice because using EBM/EBP should

validate meeting the SOC;

• Supported by industry standards; and

• Should improve patient outcomes which WILL REDUCE

COSTS/IMPROVE REIMBURSEMENTS UNDER THE ACA !!!!

The Issue

Are products the

solution to

healthcare

associated

bloodstream

infections?

Joint Commission

National Patient Safety Goal #7

Hospitals implement policies and

practices aimed at reducing the risk

of central line-associated bloodstream

infections and surgical site infections

that meet regulatory requirements

and are aligned with evidence-based

standards

http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf. Accessed 2/22/16

http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf

2011 CRBSI CDC GuidelinesIntended to provide evidence-based

recommendations for preventing

intravascular catheter-related

infections

5 major areas of emphasis:

1. Education of healthcare professionals

2. Use maximal sterile precautions (MSP)

3. Use of > 0.5% CHG skin prep

4. Avoiding routine replacement of CV

catheters

as a strategy to prevent infections

5. Use antiseptic/antibiotic impregnated

catheters and CHG impregnated

sponge dressing

(If rate of infection not decreasing

despite adherence to above 4 strategies)

Targets elimination of CRBSI

from all patient-care areas

• “strongly recommended for

implementation and supported by

some experimental, clinical, or

epidemiologic studies and a strong

theoretical rationale”

• CHG impregnated sponge dressings

are the only form of CHG dressing

recommended in new CDC guidelines

• “No recommendation is made for other

types of chlorhexidine dressings

(Unresolved Issue)”

CHG impregnated sponge

dressings received a Category 1B

recommendation for reducing

the risk of CLABSIs

O’Grady NP, Alexander M, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR

Recomm Rep 2011 April 1. Accessed 2/20/16

Product Selection“Oh…

They’ve

changed

our product

again”

“We’ve always

used this…”

“…it’s how we’ve

always done it.”

Liability Mitigation

To Make EBP/EBM the SOC- the next time

someone tells you that we’ve changed the product-

tell them- “SHOW ME THE DATA”…


• Products may look alike but BE CAREFUL….


• Vascular Product Selection to meet EBM STANDARD (HACs, VBP):

• Clinical evidence (level I,II,III evidence)-DOES IT WORK???

• Compliance with standards (which ones?)

• Active ingredient (CHG- how much?) and delivery

• Product duration/durability (does it last over time and will it crumble?)

• Infection prevention capability?

• Product Design?

• Cleared indication (for what?)

• Years on the market?/Product success (market share)?

• READ THE LABEL- what does it do and how does it do it (how does it work) and does it meet best practice requirements?

• Patient issues-impact/satisfaction

• Device issues- stability/securement/removal/application

• DOES IT PAY FOR ITSELF (supporting studies)???


• Vascular Product Selection to meet PATIENT STANDARD

(patient satisfaction):

• Which one of these things do I want in my body and why????


• Product Selection-Patient Standard

• Best product

• Least intrusive/pain/adverse effects

• Shortest duration

• Product history/market share

• Economical

Program Summary

• Standard of Care (SOC)- the caution that a reasonable

person in similar circumstances would exercise in

providing care

• To meet the SOC- practice EBM- problem solving

approach integrating both scientific and experiential

evidence

• Practicing EBM is a goal of the ACA because it will

improve patient outcomes which will:

• Reduce Readmissions

• Reduce HACs

• Improve patient satisfaction and

• Improve the bottom line ($$$)

Goals For All Lines

1. Medicare Program: Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of

Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals;

and Collection of Information Regarding Financial Relationship Between Hospitals; Final Rule, Federal Register, Volume 73, Number 161, Tuesday, August, 19, 2008. Accessed October 7, 2014

2. Medicare Program: Hospital Inpatient Value-Based Purchasing Program, Federal Register, Volume 76, Number 88, Friday, May 6, 2011. Accessed October 7, 2014

3. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY2012 Rates; Hospitals’ FTE Resident Caps for Graduate

Medical Education Payment, Federal Register, Volume 76, Number 160, Thursday, August 18, 2011. Accessed October 7, 2014

4. Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Federal Register, Volume 76, Number 212, Wednesday, November, 2, 2011. Accessed October 7, 2014

Readmission

Rates

Peripheral IV

Lines

Surgical

Drains

Home

Infusion

Arterial

Lines

Staff Compliance= Kits

CVC Lines &

PICC Lines

Dialysis

Patients

LVADs

SSIs

Provider Opportunities

in Changing Landscape/Goals

• Significantly Reduce Readmissions

• Significantly Reduce HAIs

• Increase Patient Satisfaction

• Improve Patient Outcomes

• Use Evidence-based Medicine/Practice/Protocols

Questions

© 2016 Ethicon US, LLC. All Rights Reserved. 048698-160307

Documents

HEALTHCARE IN THE USA: WHAT CLINICIANS NEED TO KNOW!