Author: WorkCompAcademy

The Leapfrog Group, an independent nonprofit focused on patient safety, released its fall 2024 Hospital Safety Grade, evaluating nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections. The Hospital Safety Grade uses up to 30 performance measures to assign an A, B, C, D or F to individual hospitals and uses a public, peer-reviewed methodology, calculated by top patient safety experts under the guidance of a National Expert Panel. It is transparent and free to the public. Leapfrog analysts use the data to observe national performance trends and state rankings.  

For fall 2024, Utah ranks number one with the highest percentage of “A” hospitals for the third cycle in a row, followed by Virginia and Connecticut in second and third. The latest Grades also show hospitals are making progress in patient safety across several performance measures including notable improvements in healthcare-associated infections, hand hygiene and medication safety.

Healthcare-Associated Infections (HAIs).

Since Leapfrog reported Hospital Safety Grades in fall 2022, when HAI rates were at their highest peak since 2016, average HAI scores have declined dramatically:

– – Central line-associated bloodstream infections (CLABSI) decreased by 38%.
– – Catheter-associated urinary tract infections (CAUTI) decreased by 36%
– – Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 34%

Hand Hygiene

As Leapfrog detailed in its 2024 Hand Hygiene Report, since Leapfrog began public reporting a tough new standard for hand hygiene in 2020, the percentage of hospitals achieving the standard has soared from 11% to 78%.

Medication Safety

Medication errors are the most common type of error that occur in hospitals and the new Hospital Safety Grade suggests improvements in how hospitals prevent them. Two of the measures in the Leapfrog Hospital Safety Grade show this progress:

Computerized Physician Order Entry (CPOE): Leapfrog tracks how well hospitals use CPOE systems to catch common errors in prescribing, such as prescribing the wrong dose or prescribing a medication with a dangerous interaction with other medications the patient takes. Studies have shown CPOE systems can reduce harm from prescriber errors by as much as 55%. In 2018, only 65.6% of hospitals met Leapfrog’s Standard, while this year, that number rose to 88.1%.

Bar Code Medication Administration (BCMA): Leapfrog scores hospitals on deployment of BCMA systems, which use barcodes at the bedside to ensure the right patient gets the right medication at the right time. In 2018, 47.3% of graded hospitals met the standard, while this year, 86.9% did.

Trends in Safety Grades by State

Key findings on state performance on the fall 2024 Leapfrog Hospital Safety Grade include:

– – The states with the highest percentages of “A” hospitals are Utah, Virginia, Connecticut, North Carolina, New Jersey, California, Rhode Island, Idaho, Pennsylvania, Colorado and South Carolina
– – Utah ranks #1 in percentage of “A” hospitals for the third Safety Grade cycle in a row.
– – California ranks in the top 10 for the first time since fall 2014.
– – There were no “A” hospitals in Iowa, North Dakota, South Dakota or Vermont.

The Leapfrog Hospital Safety Grade is the only hospital ratings program focused exclusively on preventing medical errors and patient harm. It is fully transparent, free to the public and updated biannually in the fall and spring.

Detailed hospital performance information, including patient experience and safety measures, as well as grades for individual hospitals searchable by states and localities is available.

On June 16, 2009, fire destroyed the building in which defendant Cory Michael Hoehn and his roommate, Forest Kroll, had leased an apartment.

An investigator for the building’s insurer, plaintiff California Capital Insurance Company determined that “careless smoking” on the patio caused the fire. Although the investigator reached no conclusion about who started the fire or who was present when it began, California Capital sued Hoehn and Kroll in March 2010 for “general negligence,” alleging that they caused the fire due to “improperly discarded smoking materials.” The company asked for $472,326 in damages.

In March 2010, the company attempted to serve Hoehn with a complaint and summons in the lawsuit. The affidavit supporting the return of service stated that the summons and complaint were left with Shannon Smith and identified Smith as “Girlfriend,” “Co-Occupant,” and “a competent member of the household.” A copy of the summons and complaint was also mailed to Hoehn’s address. California Capital was unable to serve Kroll and dismissed him from the lawsuit.

In April 2011, approximately a year after attempting to serve Hoehn, California Capital requested and obtained a default judgment against Hoehn for $486,528, based on an investigator’s declaration that careless smoking habits caused the fire.

In March 2018, California Capital assigned its rights to the default judgment to Sequoia Concepts, Inc. Based on a May 2018 writ of execution, the sheriff of Placer County, in January 2020, served on Hoehn’s employer an earnings withholding order, placing a lien on Hoehn’s wages in order to begin payment of the default judgment.

In March 2020, Hoehn filed a motion to set aside the default judgment. In a supporting declaration, he stated as follows: He did “not recall receiving or seeing the Summons or Complaint at any time.” Shannon Smith “did not live with” him at the apartment and he “never received a summons or complaint or any legal paperwork from [her] at any time. He “did not receive any request for judgment or notice of a default judgment hearing” in the case. He learned that there had been a default judgment against him in January 2020, when his employer informed him that a lien had been placed on his wages. He promptly contacted an attorney who filed the motion to set aside the default judgment.

Hoehn’s motion sought relief on two theories: (1) the court should exercise its power under section 473(d) to vacate the judgment; and (2) the judgment was obtained by extrinsic fraud or mistake. The trial court, following a long line of appellate court opinions, held that relief under section 473(d) was not available because Hoehn made the motion more than two years after entry of the default judgment. Regarding Hoehn’s second asserted ground for relief, the court concluded that “the fact that the proof of service of summons misidentifies Shannon Smith as a co-occupant” did not “demonstrate that the statement constitutes extrinsic fraud.”

The Court of Appeal affirmed. Relying on Trackman v. Kenney (2010) 187 Cal.App.4th 175 (Trackman) and Rogers v. Silverman (1989) 216 Cal.App.3d 1114 (Rogers) – and rejecting Hoehn’s criticisms of those decisions – the court concluded that relief under section 473(d) was time-barred. It further concluded, like the trial court, that the mistake in service was insufficient to make out a claim of extrinsic fraud that would support equitable relief from a default judgment.

The California Supreme Court reversed in the case of California Capital Insurance Co. v. Hoehn -S277510 (November 2024)

Code of Civil Procedure section 473, subdivision (d) provides in relevant part that a court “may . . . on motion of either party after notice to the other party, set aside any void judgment or order.” Under this provision, a party may move to vacate a judgment on the ground of improper service of process.

A line of decisions, followed by the Court of Appeal has held that such motions must be made within a “reasonable time” if the challenged judgment is not void on its face and its invalidity must be established by extrinsic evidence. To set the outer limit for what constitutes a reasonable time, courts have borrowed the two-year time limit of section 473.5, which applies where proper constructive service was given but the defendant did not receive actual notice.

The California Supreme Court granted review in this case to decide whether these decisions are correct. It held that they are not, and said that this judicially created rule finds no footing in the statute’s text, has not been adopted by the Legislature, and lacks any sound justification.

The Supreme Court therefore reversed the Court of Appeal’s judgment.

The Lown Institute is an independent think tank advocating bold ideas for a just and caring system for health. The Lown Hospitals Index, a signature project of the Institute, is the first ranking to assess the social responsibility of U.S. hospitals by applying measures never used before like racial inclusivity, avoidance of overuse, and pay equity.

As many as 30 million people receive medical care for a spine problem each year. While surgery is an appropriate treatment option for some, many procedures are performed despite little to no evidence of benefit, and they come with risks. Possible complications include infection, blood clots, stroke, heart and lung problems, paralysis, and even death.

In this current study, hospital overuse was measured using Medicare fee-for-service and Medicare Advantage claims data for three years of the most recently available data (2020-2022 for fee-for-service and 2019-2021 for Medicare Advantage).

Spinal fusion and/or laminectomy was defined as overuse for patients with low-back pain if they did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Spinal fusion-only cases were not considered overuse for patients with stenosis with neural claudication and spondylolisthesis. Laminectomy-only cases were not considered overuse for patients with stenosis who had neural claudication. Vertebroplasty was defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, m- yeloma, or hemangioma.

Researchers examined hospital data for common back surgeries, including spinal fusion, laminectomy, and vertebroplasty, for which clinical trials have repeatedly shown lack of benefit for certain patients. Patients with low-back pain caused by aging (excluding cases with neurologic symptoms, trauma, or structural abnormalities) receive little to no benefit from spinal fusion or laminectomy. Patients with spinal fractures caused by osteoporosis (excluding cases with bone cancer, myeloma, or hemangioma) receive little to no benefit from vertebroplasty.

Key Takeaways Include:

– – More than 200,000 procedures met criteria for overuse and are estimated to have cost Medicare around $2 billion over a three-year period.
– – On average, 14% of spinal fusions/laminectomies met criteria for overuse, with individual hospital overuse rates ranging from less than 1% to more than 50%.
– – On average, 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, with individual hospital rates of overuse ranging from zero to 50%.
– – New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy with rates over 18%. Arkansas, Kansas, Oklahoma, and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%.
– –  California overuse rate for Vetebrosplasty was 7.3% and was 13.4% for Spinal Fusion/Laminectomy.
– – U.S. News Honor Roll hospitals had varied performance. At Cleveland Clinic fewer than 1% of patient visits with osteoporotic fracture resulted in an unnecessary vertebroplasty, compared to nearly 20% at Mayo Clinic Phoenix.
– – A total of 3,454 physicians performed a measurable number of low-value back surgeries. Over three years, these physicians received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, according to Open Payments data analyzed by Conflixis.

Mount Nittany Medical Center in Pennsylvania has the highest rate of unnecessary spinal fusion/laminectomy in the nation at 62.8%. The hospital performed 535 procedures with 336 of them meeting criteria for overuse. Lown’s research also found that a single physician is responsible for 92% (308) of those overuse procedures.

Notable variation in spinal fusion/laminectomy overuse rates are present even among the nation’s most prestigious hospitals, including those on the U.S. News & World Report Honor Roll for America’s Best Hospitals. At UC San Diego (1.2% overuse rate), the hospital performed 783 procedures with only 15 meeting criteria for overuse. While at the Hospital of the University of Pennsylvania (32.6% overuse rate), 641 procedures were performed with 209 meeting overuse criteria.

According to a study published by Journal of Family Medicine and Primary Care, the side effects and risks associated with the medical intervention are called iatrogenesis. Iatrogenesis is composed of two Greek words, “iatros,” which means physicians and “genesis,” which means origin. Hence, iatrogenic ailments are those where doctors, drugs, diagnostics, hospitals, and other medical institutions act as “pathogens” or “sickening agents.”

Four Los Angeles area residents were arrested after a Department of Insurance investigation found the suspects allegedly committed insurance fraud by claiming a bear had caused damage to their vehicles, but it was actually a person in a bear costume.

Ruben Tamrazian, 26, of Glendale, Ararat Chirkinian, 39, of Glendale, Vahe Muradkhanyan, 32, of Glendale, and Alfiya Zuckerman, 39, of Valley Village, have all been charged with insurance fraud and conspiracy.

The Department’s investigation began after an insurance company suspected fraud. The suspects claimed on January 28, 2024 in Lake Arrowhead a bear entered their 2010 Rolls Royce Ghost and caused interior damage to the vehicle. They provided video footage to their insurance company, which showed the alleged bear in the vehicle.

Upon further scrutiny of the video, the investigation determined the bear was actually a person in a bear costume.

Detectives found two additional insurance claims with two different insurance companies, for the suspects with the same date of loss and at the same location. Each of those claims involved two different vehicles, a 2015 Mercedes G63 AMG and a 2022 Mercedes E350, and the suspects again appeared to use a bear costume to make it appear that a bear also entered and damaged those vehicles. They provided the video footage to the other insurance companies as well to substantiate their claims.

To further ensure it was not actually a bear in the video, the Department had a biologist from the California Department of Fish and Wildlife review the three alleged bear videos and they also opined it was clearly a human in a bear suit. After executing a search warrant, detectives found the bear costume in the suspects’ home.

The insurance companies were defrauded of $141,839, because of the alleged fraud committed by the suspects. Department detectives were assisted by the Glendale Police Department and the California Highway Patrol. The San Bernardino County District Attorney’s Office is prosecuting this case.

UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world’s eleventh-largest company by revenue and the largest health care company by revenue.

It was founded in 1977, UnitedHealth Group has grown significantly through strategic acquisitions and organic growth. Its focus on innovation, data-driven insights, and integrated care delivery models has positioned it as a major player in the healthcare industry.

In 1988, United HealthCare started its first pharmacy benefit management, through its Diversified Pharmaceutical Services subsidiary. It managed pharmacy benefits delivered both through retail pharmacies and mail. The subsidiary was sold to SmithKline Beecham in 1994 for $2.3 billion.[

In 1994, United HealthCare acquired Ramsey-HMO, a Florida insurer. In 1995, the company acquired The MetraHealth Companies Inc. for $1.65 billion. MetraHealth was a privately held company formed by combining the group healthcare operations of The Travelers Companies and MetLife. In 1996, United HealthCare acquired HealthWise of America, which operated HMOs in Arkansas, Maryland, Kentucky and Tennessee.

In 1998, the company was reorganized as the holding of independent companies UnitedHealthcare, Ovations, Uniprise, Specialized Care Services and Ingenix, and rebranded as “UnitedHealth Group”. Also in 1998, United Health Group acquired HealthPartners of Arizona, operator of Arizona’s largest AHCCCS provider

Over the following 25 years UnitedHealth continued these aggressive acquisition and merger strategies. More recently, in February 2022, UnitedHealth announced the acquisition of Change Healthcare, the largest health payments platform in the US, which the US Justice Department tried to block on antitrust grounds; the sale went through by September. But inn February 2024, the subsidiary was brought completely down by the 2024 Change Healthcare ransomware attack, and the Justice Department announced that it was opening a new antitrust and Medicare overcharging probe.

The company is ranked 8th on the 2024 Fortune Global 500.and had a market capitalization of $474.3 billion as of July 15, 2024. The company has a substantial impact on the U.S. healthcare system. Its scale and influence allow it to negotiate favorable contracts with healthcare providers, pharmaceutical companies, and medical device manufacturers. The company has also been at the forefront of initiatives to improve healthcare quality, reduce costs, and enhance patient outcomes.

In recent years, UnitedHealth Group has been actively expanding its global footprint and investing in emerging technologies like artificial intelligence and telemedicine. And it has recently proposed a $3.3 billion acquisition of Amedisys, a leading home health and hospice care provider. This deal aims to expand UnitedHealth’s presence in the home care market and integrate it with its existing healthcare services.

Founded in 1982, Amedisys has grown steadily over the years through organic growth and acquisitions. The company has a significant presence in the U.S., with operations in 37 states and the District of Columbia. Amedisys employs over 21,000 individuals and serves millions of patients annually.

However, Amedisys has been involved in legal disputes and regulatory scrutiny, including allegations of fraud and improper billing practices. The company has also faced challenges related to reimbursement rates and staffing shortages.

In 2023, Amedisys agreed to be acquired by Optum, a subsidiary of UnitedHealth Group, in a deal valued at $3.3 billion. And the U.S. Department of Justice (DOJ) and several states have filed a lawsuit this month in the United States District Court for the District of Maryland to block the deal, arguing that it would reduce competition and harm consumers. O

“We are challenging this merger because home health and hospice patients and their families experiencing some of the most difficult moments of their lives deserve affordable, high quality care options,” said Attorney General Merrick Garland in a statement following the complaint’s filing in Maryland federal court.

To address some of the overlaps between UnitedHealth and Amedisys, UnitedHealth has proposed to divest certain facilities to VitalCaring Group (VitalCaring). But as the complaint alleges, the proposed divestiture does not alleviate harm in over 100 home health, hospice, and labor markets, which generate at least a billion dollars in revenue annually, serve at least 200,000 patients, and employ at least 4,000 nurses.