Becker's Hospital Review

42 CMO / CARE DELIVERY Chicago Hospital Sues Leapfrog for Defamation By Ayla Ellison S aint Anthony Hospital in Chicago sued Leapfrog for defamation, alleging the hospital ratings agency knowingly used incorrect in- formation to lower the hospital's letter grade for patient safety, according to the Cook County Record. In response to the lawsuit, Leap- frog claimed the hospital had months to review its grade and chose to do nothing until a few days before the grades were published Oct. 31. The lawsuit, filed in Cook County Circuit Court, alleges Leapfrog low- ered Saint Anthony Hospital's grade to "C" in its fall 2017 report, down from previous "A" grades. The hospital claims Leapfrog lowered its grade for allegedly only pre- scribing medications electronically 50 to 74 percent of the time. Howev- er, Saint Anthony Hospital said at least 95 percent of prescriptions from its physicians were electronic and that data was provided to Leapfrog. The hospital alleged it informed Leapfrog of the error numerous times in October, but Leapfrog did not say it would correct the issue prior to releasing its ratings. Saint Anthony contends Leapfrog's refusal to issue the hospital a higher letter grade and correct the alleged error amounts to defamation, according to the report. Leapfrog contends the hospital's "C" for patient safety was based on self-reported data submitted by Saint Anthony June 7. Hospitals graded by Leapfrog could update their responses until Aug. 31, and were able to review their data for three weeks, beginning Sept. 13. Leapfrog claims Saint Anthony Hospital waited until six days before the publication of the fall 2017 report to indicate it submitted inaccu- rate data in June. Leapfrog claims it offered to update information for the spring 2018 report. n 1.6k Kansas City Physicians Form Clinically Integrated Network By Leo Vartorella N early 1,600 Kansas City, Mo., area physicians across the Uni- versity of Kansas Health System, North Kansas City Hospital, Merriam-based Shawnee Mission Health and Kansas City Met- ropolitan Physician Association banded together to form a clinical in- tegration network called Centrus Health Kansas City, according to The Kansas City Star. The group has an agreement with Blue Cross and Blue Shield of Kansas City and is in talks with Medicare to form an ACO. If the ACO is approved, 90,000 Medicare and Blue Cross members will be in the network. "It's a really unique opportunity for this sort of delivery model to come to Kansas City," said Jill Watson, executive director of Centrus Health, according to The Kansas City Star. "We know the city is asking for it and we're pretty excited about the partners we put together and the direction of the physician leadership that's involved." Centrus Health physicians have agreed to share patient data to identify which physician groups excel at certain medical specialties. This will help them share methods and improve quality of care across the network. n Unconscious Patient's 'Do Not Resuscitate' Tattoo Creates Ethical Dilemma for ER Staff By Megan Knowles E mergency room staff at a Florida hospital found an unconscious patient with "do not resuscitate" tattooed on his chest, prompting confusion and ethical concern, according to a case report in e New England Journal of Medicine. Paramedics brought the unconscious 70-year-old man to the ER, where he was found to have an elevated blood al- cohol level. e man had a history of chronic obstructive pulmonary disease, diabetes and an irregular heart rate. e "do not resuscitate" tattoo on his chest underlined "not," and included what staff presumed to be his signa- ture. e man arrived at the ER with no identification or family present, which prompted the social work depart- ment to assist in contacting his next of kin. ER staff failed to help the patient regain a level of con- sciousness where he could adequately discuss his goals for care. e staff initially decided not to honor the pa- tient's tattoo. ey reasoned they should not make an ir- reversible choice due to the situation's uncertainty. How- ever, this decision le staff conflicted and they requested an ethics consultation. e ethics consultants advised staff to honor the patient's DNR tattoo. ey reasoned staff could infer the tattoo expressed the patient's authentic preference and added that laws are not always flexible enough to respect a pa- tient's best interest. A DNR order was written, and the social work depart- ment obtained a copy of the patient's Florida Depart- ment of Health "out-of-hospital" DNR order, which was consistent with his tattoo. e patient died aer his health continued to deteriorate throughout the night, without receiving CPR. "is patient's tattooed DNR request produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs that tattoos might repre- sent permanent reminders of regretted decisions made while the person was intoxicated," the authors wrote. "We were relieved to find his written DNR request, es- pecially because a review of the literature identified a case report of a person whose DNR tattoo did not re- flect his current wishes." e case report authors noted this incident does not sup- port or oppose the use of tattoos to express end-of-life wishes for patients who are incapacitated. n

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