March 2019, Volume XXXII, No 12
Northfield Hospitals and Clinics is moving forward with expansions on both its Northfield Clinic and Birth Center in 2019.
The Northfield Clinic has outgrown its current space, as it continues to gain new providers and more patients. It needs room for growing services, such as family medicine, pediatrics, internal medicine, and specialty care, as well as new services. The expansion will add exam rooms and space for providers joining the practice, using a design that supports its care team model.
The Birth Center welcomes about 550 babies per year, and needs more space to accommodate more births simultaneously. The expansion project will increase its capacity to allow for 750 births per year, and add an operating room specifically for C-sections.
The two projects will cost about $13 million total. The Northfield City Council approved the expansion plans in early March, and now the Northfield Hospitals and Clinics board is moving forward to prepare an RFP for architect and construction services. They plan to begin construction in the spring.
Summit Orthopedics’ Eagan Surgery Center has become the first surgery center in the nation to earn The Joint Commission’s Certificate of Distinction for the Management of Spinal Fusion.
To earn the certification, medical facilities must meet a robust and challenging list of requirements in areas including program management, clinic care, patient self-management, clinical information management, and performance measures. Since the spinal fusion certification was introduced two and a half years ago, 12 facilities have earned it. All of them are hospitals.
Nicholas Wills, MD, a spine surgeon at Summit Orthopedics, said that despite earning its Certificate for Distinction for spinal fusions, the surgery center focuses first on conservative, nonsurgical treatments for its patients, pursuing surgery only when all other treatment options have been exhausted. He noted that just 15 percent of Summit Orthopedics’ spine patients are treated with surgery.
“For those patients who do undergo spinal fusion surgery at Summit, we have a standardized approach to every aspect of their care, and our entire staff adheres to that protocol,” said David Strothman, MD, a spine surgeon at Summit Orthopedics. “In this way, we minimize the risks associated with the complexity of spinal fusions. Based on our outcomes, I would say that our approach is working very, very well.”
According to Strothman, who developed Summit Orthopedics’ spinal fusion protocols, since the Eagan location opened in March 2017, of the more than 150 spinal fusions that have been performed, the incidence of infection was zero.
An analysis of hospital prices from National Nurses United and Minnesota Nurses Association (MNA) shows that Minnesota hospitals are charging an average of 212 percent more than it costs them to provide care for patients. They note that the cost for care includes not only direct labor and supplies, but also administrative and general costs, such as maintenance and housekeeping.
Sources for the report, called Minnesota’s Most and Least Expensive Hospitals, include 2016-2017 Medicare Cost Reports for each of the 111 hospitals included in the report, as well as data collected by the Bureau of Labor Statistics, the Center for Medicare and Medicaid Services, and the American Hospital Association. Medicare Cost Reports provide data on hospital charges and costs for a variety of services, and the charges are often referred to as charge master prices—most patients won’t pay the base charge master price, but it sets a starting point for negotiations between the hospital and insurance companies over reimbursement rates. These prices impact the cost of care, as those higher rates are often passed from the insurance company on to the patients, according to MNA.
The cost-to-charge ratio (CCR) is a way to measure the relationship between hospital costs and charge master prices. If charges are higher than the costs, the CCR will be higher than 100 percent, and if the charges are lower than costs, the CCR will be below 100 percent. The average CCR in 2016 for Minnesota hospitals was 212 percent. The lowest CCR at a hospital was 108 percent and the highest was 383 percent.
Notable takeaways from the report include that hospitals with higher CCRs are mostly located in larger metro areas; providers with high CCRs tend to be part of larger health care systems; and high CCR hospitals had a higher ratio of excess revenue over expenses (profit) than those with lower CCRs. In addition, Minnesota hospitals’ profit margins have steadily risen over the past 20 years, with little deviation from the trend, and hospital spending as a percentage of health expenditures has increased over the past 20 years from 27.7 percent to 33.8 percent.
MNA notes that unless something changes, this trend will only continue.
The University of Minnesota and Fairview Health Services are now the first in the world to use digital medicines to allow doctors to monitor patients undergoing cancer care. Digital medicine technology is used to help patients manage medications for a variety of diseases, including diabetes and hypertension, but it has not been used for cancer until now.
“When we give people chemotherapy in the clinic with an intravenous drug, we’re able to assess the dose and timing and make sure they’re well enough to continue getting the treatment,” said Edward Greeno, MD, oncologist/hematologist and professor in the University of Minnesota Medical School’s department of medicine. “But when you send them home with a bottle of pills, you don’t know when they’re taking them or if they’re well enough to take them.”
According to Greeno, the technology could significantly improve cancer care because the timing and dosage of chemotherapy is critical. He and other physicians at the Masonic Cancer Clinic have begun prescribing pills embedded with small, ingestible sensors. The sensors, designed by Proteus Digital Health, are the size of a grain of sand and can track information including heart rate, activity level, and sleep cycle.
Once a patient ingests the pill, it sends the data to a small patch on the patient’s abdomen, which then connects to a mobile app that both the patient and their physician can access. The technology will allow physicians to ensure patients are taking their medications as prescribed. They also can automatically tell how many pills a patient has left in their prescription, which helps them better manage refills. In addition, according to the researchers, it can give a sense of comfort to some patients, helping them take a more active role in managing their medication.
Mayo Clinic has received a philanthropic gift of $5 million to support the renovation and expansion of the Mayo Clinic Health System Cancer Center in La Crosse, Wisconsin.
Stephen and Barbara Slaggie of Marco Island, Florida, and Winona, Minnesota, gave the gift in recognition of their long, 70-plus-year relationship with Mayo Clinic. Mayo Clinic plans to name the cancer center in honor of the Slaggie family. Naming details will be shared at the expansion opening later in 2019.
The expansion project is already underway at the cancer center, and construction is scheduled to be completed this year. It will add 3,900 square feet of space and enlarge the pharmacy area. It will also add nine exam rooms and nine treatment chairs for medical oncology, as well as improve the workflow efficiency of the space.
The center opened in September 2004, and since then, the number of patients it serves has doubled. The expansion will allow Mayo Clinic to meet the current patient demand and allow for future growth.
The number of reportable adverse events at Minnesota hospitals, ambulatory surgical centers, and community behavioral health hospitals has reached a new high after slowly increasing for five years, according to the 15th annual public report from the Minnesota Department of Health (MDH). The reporting system tracks 29 serious events, such as wrong-site surgeries, severe pressure ulcers, falls, and serious medication errors.
Between October 2017 and October 2018, there were 384 events out of 5 million patient days. MDH notes that though the number of events increased again, they remain very rare with a frequency far below 1 percent of hospitalizations, and that number has remained steady over the past 15 years of reporting. The report shows that the increase in adverse health events during this period was largely driven by a rise in pressure ulcers, retained foreign objects, and the loss or damage of irreplaceable biological specimens.
“This system has given us a much deeper understanding of how and why adverse events occur, and it has helped create a culture of learning and improvement across Minnesota. But despite earnest collaboration and effort, in the last few years of reporting, the number of reported events has plateaued in several categories and increased in others,” said Jan Malcolm, Minnesota commissioner of health. “It is clear there is still more to do to keep patients safe every time they receive care. We look forward to working with our partners this year to ensure this system can continue to improve, evolve, and get results.”
Of the reports during this period, 31 percent resulted in serious injury (118 events) and 2 percent (11 events) led to the death of a patient. In the past, falls, severe ulcers, medication errors, and product/device malfunction were the most common causes of serious patient injury or patient death, and that pattern continued in 2018. Five of the 11 deaths were associated with falls, three with the death of a neonate, two with medication errors, and one as the result of a suicide.