Ratios in ICUs, 340B Cuts, and more...

Latest Study: Mandated Ratios in ICUs Don’t Improve Care

Did the Massachusetts law that mandated nurse staffing ratios in intensive care units result in any improvements to patient care in those units?


According to a new peer-reviewed study published in Critical Care Medicine, the costly, government-mandated ratios did not reduce mortality, and had no effect on nursing-sensitive measures relating to bloodstream and urinary tract infections, pressure ulcers, and falls.

The authors from Beth Israel Deaconess Medical Center wrote: “Given the excess costs of enacting and enforcing statewide legislation to implement acuity-guided ICU nurse staffing, future efforts to regulate patient-to-nurse ratios should carefully first consider the extent of the effects of the mandate on nurse staffing levels. In line with previous studies outside of the ICU, our study of ICU nurse staffing adds further evidence suggesting that statewide legislation to mandate nurse staffing strategies may not effectively improve patient outcomes.”

The Massachusetts ICU law was signed into law on June 30, 2014, setting a maximum patient-to-nurse assignment of 2:1 – but without any flexibility. That rigidity has resulted in Massachusetts hospitals reporting, since the law’s implementation, increased wait times and patients boarding in emergency departments; delayed transfers of patients into ICUs; clinically unnecessary patient transfers between hospitals; and, in neonatal ICUs, the splitting up of twins if one infant required a more intense level of critical care.

The Critical Care Medicine study adds a scientific foundation to the anecdotal problems hospitals have reported since the imposition of ICU ratios.  And the study adds yet another layer to the ever-increasing volume of studies that have found no direct link between a set ratio and improved patient outcomes.

As the authors note, only one state – California – has mandated ratios in its hospitals, adding, “Although California regulations were associated with an increase in nurse staffing, outcomes of hospitalized [patients] did not improve after the California law, findings similar to Massachusetts ICUs.”

The proposed Question 1 on the Massachusetts statewide ballot this November would extend the unproven ratio scheme from ICUs to all units in a hospital – a move that is opposed by the American Nurses Association – Massachusetts, MHA, and a growing coalition of health and community interests.

Learn more about No on Question 1 by visiting here.

Hospitals File Suit to Halt 340B Cuts

The American Hospital Association joined by other hospital interests filed suit in U.S. District Court to stop a nearly 30% reduction in Medicare payments to hospitals for purchase of outpatient drugs under the 340B program.

The payment cut totals $1.6 billion nationwide and will especially harm hospitals and clinics serving low-income patients. Congress created the 340B program in 1992 to help these providers by offering them drug discounts.  Under the 340B program, manufacturers of prescription drugs, as a condition of having their outpatient drugs covered through Medicaid, are required to offer 340B hospitals and clinics outpatient drugs at or below an applicable, discounted, statutorily-determined ceiling price. “In general, drug manufacturers must offer a minimum discount of between 13% and 23.1% depending on the type of drug,” according to the AHA suit.

Through its proposed Outpatient Prospective Payment System (OPPS) rule issued in July 2018, CMS proposed a 28.5% reduction in the 340B reimbursement rate.

The AHA suit contests the method CMS used to reduce the reimbursement, arguing that it violated the Administrative Procedure Act and exceeded the statutory authority of the Health & Human Services Secretary.

CDC Seeks Hospital Info to Inform Opioid Epidemic

In the battle against the opioid epidemic, the Centers for Disease Control and Prevention (CDC) is seeking data from hospitals across the U.S.

Specifically, the National Hospital Care Survey (NHCS), conducted by CDC’s National Center for Health Statistics (NCHS), is seeking a nationally representative sample of hospitals to submit all data on patients seen in inpatient, outpatient, and emergency departments. Data elements collected include patient demographic information, diagnoses, procedures, medications, laboratory tests and results, and personally identifiable information (PII).

Why PII? The CDC says, the personal information “uniquely positions the NHCS to study opioid-involved health outcomes and hospital care utilization. Repeat encounters and post-discharge rates for opioid-involved hospital encounters can be analyzed and calculated. Additionally, clinical notes collected via electronic health records may potentially serve as a rich information source on specific drugs involved in the emergency department visit, the nature of misuse or poisoning, and other risk factors for opioid-involved hospital encounters.”

For more information, please visit here to review project materials and publications. For questions, contact Margaret Noonan, Team Lead of the Hospital Care Team, NCHS, at mnoonan2@cdc.gov.

Ergonomics Program Builds on Hospital Improvement Efforts

The Center for Promotion of Health in the New England Workplace (CPH-NEW) has released an online continuing education program to help nurses prevent musculoskeletal injuries in the clinical care setting.

The new online education program, developed by CPH‐NEW occupational ergonomics experts and faculty at the Solomont School of Nursing at UMass Lowell, offers 10 essential components of an effective prevention program to reduce patient handling injuries.

This free program consists of six self-paced online modules aimed at reducing risks for work-related musculoskeletal disorders. Participants will learn to use ergonomic principles, work practice, and administrative controls to identify and reduce hazards associated with patient handling and non-patient handling tasks.

The program is intended to supplement the work that most hospitals have done to improve patient handling in an effort to protect both patients and the healthcare workforce.

To learn more about the Ergonomics in Healthcare program, visit here.

The Role of Social Determinants and Cultural Awareness in Caring for Patients

Friday, October 19; 8:30 a.m. - 2:30 p.m.
MHA Conference Center, Burlington, Mass.

Social determinants of health continue to get the recognition they have always needed in healthcare. Payers are gathering data and providing financing and methods to enable healthcare providers be more creative in treating the whole person. Providers are responding with new programs to meet patients’ broader needs. Join us at this conference to hear more about how caregivers and communities are coming together to provide innovative and targeted care to help patients get and stay healthy.  For more information about speakers, registration, and more, visit here.

John LoDico, Editor