Becker's Hospital Review

Save the date! Becker's Hospital Review 6th Annual Meeting — May 7-9, 2015 — Chicago. Please call 800-417-2035 to register. 8 The Ebola outbreak-related event that sent the larg- est ripples through the country was the first diagno- sis of a patient with Ebola on U.S. soil. Thomas Eric Duncan, who came to the U.S. from Liberia, pre- sented at Texas Health Presbyterian Hospital in Dal- las on Sept. 26 with symptoms of Ebola. He was sent home, then returned to the hospital Sept. 28, when he was placed in isolation and diagnosed with Ebola. While treating Mr. Duncan, who later died from the infection, two nurses at Texas Health Presby- terian Hospital contracted the virus and became the nation's first transmitted cases of Ebola. Some nurses blamed this transmission on improper personal protective equipment provided to nurses and incomplete education on Ebola virus disease. The missteps in handing Mr. Duncan's case were acknowledged by Texas Health Resources as "mis- takes" and have been investigated. Those mistakes have led to process improvement, however. Since those events in Dallas, the CDC has updated its Ebola personal protective equipment guidelines to be more stringent. Additionally, the agency set up a dedicated CDC Response Team that can be at any hospital in mere hours if a patient is diag- nosed with Ebola. The team can help healthcare professionals follow strict protocols, keep patients and healthcare workers safe and prevent further transmission of the illness. The end of an Ebola outbreak in a country hap- pens once 42 days have passed with no new transmitted cases, according to the World Health Organization. The WHO declared the end of the outbreak in Nigeria in October, but experts have said the Ebola outbreak worldwide will likely not be contained for months. VA healthcare scandal Late last year, a report filed by the U.S. Depart- ment of Veterans Affairs found employees at one outpatient clinic in Fort Collins, Colo., falsified appointment records to meet performance goals. According to the manipulated documents, pa- tients seeking care were all seen within the 14-day required limit when, in fact, many patients were waiting months for an appointment. The initial report in Colorado spurred more allega- tions of secret wait lists and manipulated appoint- ment records against VA hospitals and clinics in several states across the country including facilities in Arizona, Colorado, Florida, Illinois and Wyo- ming. Additionally, investigations by HHS' Office of the Inspector General of the Phoenix VA Health Care System uncovered a secret patient wait list hospital leaders used to hide the actual amount of time patients were waiting for appointments. The allegations against the Phoenix VA also claimed 40 patients died while waiting for care. The OIG was unable, however, to prove that scheduling delays caused any patient deaths. Even so, the scheduling and quality of care prob- lems identified by the OIG eventually led to the resignation of Eric Shinseki, the former Secretary of Veteran's Affairs, in May. Robert Petzel, the VA's undersecretary for health, also stepped down. In response to the scandal, President Barack Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014, allow- ing the VA Secretary to fire or demote VA execu- tives or supervisors who have been found to have manipulated medical and patient data. The law also appropriated roughly $16 billion in funding for the VA to hire more physicians and nurses, build more facilities to expand capacity, and generally overhaul the system. Health insurance marketplaces meet targets, but not without drama One of the most closely watched healthcare stories during the early part of the 2014 was the contin- ued rollout of the healthcare insurance market- places. Launched the same day the federal gov- ernment shut down over failure to compromise on the spending bill, the federal marketplace site was plagued from the start, suffering numerous technical difficulties that impeded enrollment in the plans. As a result, the Obama administration pushed back the deadline by which Americans had to enroll in health coverage or face a fine to March 31 — six weeks after its initial deadline. Democrats and Republicans alike wanted to know: How many Americans enrolled? Did the glitches mean the Democrats fell far short of their goal of enrolling 7 million Americans in marketplace plans? And if so, how would they deal with the fall out? In February, the Congressional Budget Office provided the answer. It lowered its estimate of marketplace enrollees to 6 million, a significant shortfall for the law's supporters. But, by summer, the pages had turned, and it appeared HHS' ef- forts to promote coverage for all had paid off. As of mid-august the department reported some 7.3 million people were enrolled in marketplace plans and had paid their premiums. As of July, 8 million people had newly enrolled in Medicaid. While the marketplaces did ultimately reach their enrollment targets (and decrease the number of uninsured Americans by roughly 9.5 million, ac- cording to The Commonwealth Fund), it was mostly just politicians and policy wonks who read this and similar follow-up studies. Most Americans simply remember the headlines about the site's major problems, which could influence their deci- sion to enroll through an exchange through 2015 — a year that many analysts say could be even more challenging for the exchanges as even more Americans visit them to explore coverage options. Obama administration's top healthcare officials keep leaving office The healthcare industry has experienced major shifts over the past year, including changes in the very faces of healthcare leadership on the federal level. Following the glitch-ridden rollout for the federal health insurance exchange website in 2013, many unhappy customers, critics of the Patient Protec- tion and Affordable Care Act and Republican law- makers began calling for the resignation of Kath- leen Sebelius, then HHS Secretary. In April, two weeks after the culmination of the first open enrollment period, Ms. Sebelius obliged by stepping down, acknowledging that the launch of HealthCare.gov was "flawed and unacceptable." In June, the Senate voted to confirm the nomi- nation of Sylvia Mathews Burwell — the former director of the Office of Management and Bud- get — to replace Ms. Sebelius as HHS secretary. Since taking up her current role, Ms. Burwell has sworn to recover federal funds spent improp- erly on flawed state exchanges. HHS isn't the only government body that under- went leadership changes in 2014. In August, U.S. Chief Technology Officer Todd Park announced his plan to resign his position by the end of the year to move to the West Coast, though he will continue to serve in the Obama administration by recruiting technology professionals for government projects. Weeks later, Mr. Park was replaced as CTO by Me- gan Smith, the former vice president of new busi- ness development at Google. Most recently, the Office of the National Co- ordinator for Health Information Technology underwent a major leadership change. National Coordinator Karen DeSalvo, MD, stepped down from her position at the ONC to join HHS' Ebola response team where she'll serve as assistant sec- retary for health and will work directly with the HHS secretary, Ms.Burwell. Lisa Lewis, the COO of ONC, will serve as acting coordinator until the position is filled permanently. CEO turnover hits record high 2014 has been marked by unprecedented CEO turnover in the healthcare industry. The rate at which health system and hospital leaders are leaving their posts raises a new set of concerns to add to the list of issues the industry finds itself facing at the end of this year. If hospitals and health systems cannot retain leaders, how can they address the long-term goals they set for their institutions? How can CEOs establish culture and encourage change if they aren't around long enough to see change realized? According to the American College of Health- care Executives' latest report, CEO turnover reached 20 percent in 2013 — the highest since ACHE began tracking CEO turnover in 1981. The annual rate has fluctuated between 14 and 18 percent from 2003 to 2012, but has trended upward in recent years. The sharp increase can primarily be attributed to the emerging trend toward consolidation and baby boomer CEOs seeking retirement, according to Deborah J. Bowen, president and CEO of ACHE. CEO turnover can negatively impact a hospital or health system in several ways. Abrupt or poorly The Most Memorable Healthcare Stories of 2014 (continued from cover)

• Cover