Governor Rendell Says New Health Care Reform Measures Could be 'Prescription for Nation'

Innovative Reform Measures Will Improve Access; Quality of Care

Jul 20, 2007, 01:00 ET from Pennsylvania Office of the Governor

    PHILADELPHIA, July 20 /PRNewswire-USNewswire/ -- Governor Edward G.
 Rendell said the state today took its first steps in making health care
 more accessible and eliminating deadly hospital-acquired infections when he
 officially signed the first pieces of his Prescription for Pennsylvania
 health care reform plan into law. He also said people all over the United
 States could also benefit if states, or the federal government, follow the
 commonwealth's lead.
     Bills allowing advanced-practice nurses, physicians' assistants and
 dental hygienists to practice to the full extent of their education and
 training, and a bill to more aggressively attack and eliminate
 hospital-acquired infections were passed by the General Assembly.
     The Governor signed the bills during a ceremony at the University of
 Pennsylvania School of Nursing -- the same site where he initially
 announced the Prescription for Pennsylvania in January. The event was
 Webcast to a group of legislators and stakeholders at the VA Healthcare
 System, University Drive Division in Pittsburgh, another of the Governor's
 early stops on his Prescription for Pennsylvania bus tour.
     "We started implementing our aggressive health care reform agenda in
 May with an executive order that established a program to better manage
 chronic diseases and address health equity issues. Today, we added
 initiatives so Pennsylvanians will have greater access to health care
 providers and they will be protected from deadly hospital-acquired
 infections," Governor Rendell said. "These are the kinds of common sense
 programs that improve and save people's lives and save money.
     Governor Rendell's Prescription for Pennsylvania will increase access
 to affordable health care coverage for every uninsured Pennsylvania
 resident, improve the quality of care and control health care costs for
 businesses and employees.
     The Governor's plan will help to curb soaring health care costs that
 threaten continued economic expansion and needlessly cost taxpayers
 billions of dollars a year.
     The first set of bills approved by the General Assembly will make it
 easier for patients to seek appropriate care where and when they need it.
 It will also help to reduce costs by enabling nurses, advanced training
 nurse practitioners, clinical nurse specialists, nurse midwives, physician
 assistants and dental hygienists to practice to the fullest extent of their
 training and skills. For example, Pennsylvania is currently the only state
 that does not allow nurse midwives to prescribe for their patients or allow
 advanced-practice nurses to order durable medical supplies like walkers and
 wheel chairs for bedridden patients. The bills signed today by Governor
 Rendell remedy that.
     "Pennsylvania lags behind other states in fully using all licensed
 health care providers, and these initiatives will remove barriers that have
 kept them from practicing to the greatest extent allowed by their education
 and training," the Governor said.
     The second initiative focuses on improving patient safety and
 containing costs by eliminating hospital- and health-facility-acquired
 infections. The Governor noted that most hospital-acquired infections are
 avoidable. In Pennsylvania, however, the number of hospital infections
 reported last year was 19,154, which led to nearly 2,500 deaths and more
 than $3.5 billion in hospital charges.
     One example of a hospital-and health-facility-acquired infection
 specifically addressed in the Prescription for Pennsylvania is MRSA, a type
 of drug-resistant bacteria that is commonly carried inactive on the skin
 but can be deadly if it is introduced into the bloodstream. In 2004, there
 were 13,722 hospitalizations in Pennsylvania in which the patient had an
 MRSA infection -- a rate of 7.4 per every 1,000 inpatient hospitalizations.
 Data shows that 8.9 percent of those patients, or 1,221 people, died as a
 result of contracting MRSA.
     MRSA is almost exclusively contracted in a hospital setting, but can be
 virtually eliminated from health centers through simple patient-safety
 procedures. Groundbreaking work by Pennsylvania's veteran's administration
 hospitals has resulted in the near elimination of MRSA infections in those
     According to the Pennsylvania Health Care Cost Containment Council, or
 PHC4, the average charge of hospitalization in 2005 for a patient who
 became infected with a hospital-acquired infection was $185,260 and the
 average charge for a patient without an HAI was $31,389.
     The Governor said now that two large components of Prescription for
 Pennsylvania have been passed and a third on the improved management of
 chronic diseases is underway by executive order, he is looking forward to
 working with the legislature to enact the final pieces of his reform plan.
     To further expand access to care, the Governor said he will hold to his
 commitment to enact Cover All Pennsylvanians, or CAP, a program offering
 affordable basic health coverage to small businesses and the uninsured
 through the private insurance market.
     He said he will also push for passage of common sense insurance reforms
 that will make it illegal for insurers to use factors other than age,
 geographic location and family size when setting rates for small groups and
 individuals and making sure that a small group or individual paying the
 highest charge for a certain insurance product is paying no more than
 double those being charged the least.
     More information on Governor Rendell's visionary Prescription for
 Pennsylvania health care reform plan may be found at
     The Rendell administration is committed to creating a first-rate public
 education system, protecting our most vulnerable citizens and continuing
 economic investment to support our communities and businesses. To find out
 more about Governor Rendell's initiatives and to sign up for his weekly
 newsletter, visit his Web site at:
     EDITOR'S NOTE: Additional details of the measures signed by the
 Governor follow.
     Senate Bill 968 -- Erickson / DeLuca -- Health Care Acquired Infections
     -- Hospital-acquired infections (HAIs) are infections that patients
        contract while in the hospital.  At the time of admission the infection
        was not present or developing.
     -- Most HAIs are preventable, yet over 2,478 Pennsylvanians die each year
        with HAIs.
     -- In 2005, Pennsylvania hospitals reported 19,154 cases of HAIs to the
        Pennsylvania Health Care Cost Containment Council, which resulted in
        hospital charges of $3.5 billion that year.  (This is not the total
        number of HAIs for 2005, as hospitals were not required to report all
        HAIs until 2006).
     -- In 2005, the average charge for a hospitalization for a patient who
        became infected with an HAI was $185,260 and the average charge for a
        patient without an HAI was $31,389.  In 2005, the average payment for a
        hospitalization for a patient who became infected with an HAI was
        $53,915 and the average payment for a patient without an HAI was
     -- Hospitals vary considerably in their ability to identify and report
        HAIs.  By using electronic surveillance systems to identify infections,
        hospitals eliminate the potential for error in determining what is or
        is not an HAI.
     SB 968 focuses on surveillance and reporting to address both
 transparency and evidence based responsive infection control procedures.
 Pennsylvania is now the National leader on this issue as no other state has
 ever implemented a plan so comprehensive for the purpose of eliminating
 health care acquired infections.
     Health care facility referred to in the legislation includes hospitals
 and nursing homes; except in reference to Infection Control Plans which are
 to be completed by hospitals, nursing homes, and ambulatory surgical
     Infection Control Plans
     Facilities have 120 days to develop and implement an internal infection
 control plan after the effective date determined in SB 968.
     That infection control plan (ICP) will be completed according to the
 following requirements:
     -- The infection control plan must be developed by a multi-disciplinary
        committee including medical staff, administrative staff, laboratory
        personnel, nursing staff, pharmacy staff, physical plant personnel, a
        patient safety officer etc.
     -- The ICP must include a system to identify and designate patients known
        to be colonized or infected with MRSA or other multi-drug resistant
        organism (MDRO) including:
       -- Cultures and screenings of all nursing home residents admitted to a
       -- Identification and cultures and screenings of all "high risk"
       -- Procedures for identification, cultures, screenings, and follow up
          care for staff who may have had exposure to a patient known to be
          colonized with an MDRO before that patient was identified
     -- An infection control intervention protocol based on nationally
        recognized, evidence based standards including isolation procedures,
        physical plant operations, use of antimicrobial agents, education
        programs for personnel, and fiscal and human resource requirements.
     Within 14 days of implementation of the ICP, a facility must submit the
 plan to the department of health for review for compliance with the
 required standards. When the plan is submitted the health care facility
 must notify everyone in the facility about the plan.
     -- Nursing homes will report infections based on the Centers for Disease
        Control definitions in accordance to what is determined by the
        department of health and the patient safety authority.
     -- Hospitals shall make reports within 180 days of enactment to the
        National Health Safety Network and the CDC.
     The reporting will be for all patients throughout the entire facility
 at all times. It will be conducted on a monthly basis and each hospital
 shall authorize the Department of Health, the Patient Safety Authority, and
 the Pennsylvania Health Care Cost Containment Council to access the data
 from the National Health Safety Network.
     If a hospital does not authorize the department, the authority, and the
 council to access the data from the NHSN, the hospital must continue
 reporting with PHC4 and the Patient Safety Authority.
     Electronic Surveillance
     Each hospital shall do an assessment by Dec. 31, 2007, to determine
 their ability and capacity to implement a qualified electronic surveillance
 by Dec. 31, 2008.
     -- If a hospital's assessment makes a positive determination they should
        begin implementing electronic surveillance prior to the Dec. 31, 2008,
     -- If a hospital's assessment shows they cannot implement a system by Dec.
        31, 2008, then they shall continue using their current surveillance
        system until such time as they implement a system with assistance from
        the Department of Health.
     Quality Improvement Payments
     If by Jan. 1, 2009, a facility shows a 10 percent reduction in
 infections that facility will be eligible to receive a quality improvement
 payment. Every year after that the Department of Public Welfare and the
 Department of Health determine potential payments based on a facility
 meeting benchmarks determined by DOH for each facility.
     If a facility implements a qualified electronic surveillance system,
 that facility is eligible for additional payments if they show reductions
 as determined by the department in reviewing benchmarks.
     No facility will receive a quality improvement payment if it is in
 violation of Health Care Facilities Act and payments will only be made
 dependent upon available funds.
     The Department of Health will act as a partner to health facilities in
 implementing the HAI plans in a variety of ways:
     -- Developing a public health awareness campaign about health care
        acquired infections and health care facility quality indicators.
     -- Reviewing and determining feasibility of using community organizations
        as a foundation for community based infection control outside of health
        care facilities.
     -- Reviewing infection control plans for compliance.
     -- Developing recommendations for infection control protocols and
        procedures for various incidents.
     -- Developing recommendations for screenings and cultures for MRSA and
     -- Reviewing assessments to determine feasibility of e-surveillance and
        assist in realizing that capacity in facilities.
     -- Developing a methodology for analysis of NHSN data to compare a
        facility to itself over time, to similar facilities across the
        Commonwealth, and to other facilities across the nation to determine
        capacity, proficiency and effectiveness of ICP as well as to
        continually perform program analysis on best practice standards used in
     -- Using reporting data and comparative analysis to establish benchmarks
        which facilities must meet in reducing health care acquired infections.
     Nursing Homes Assessment
     Beginning on July 1, 2008, each nursing home shall commence reporting
 of infection rates and shall pay the department a surcharge on its
 licensing fee as necessary to provide sufficient revenue for the PSA to
 perform its responsibilities with regards to nursing home reporting. HB
 1251 -- 1255 and SB 455 Scope of Practice
     A significant percentage of adult and pediatric primary care can be
 provided by nurse practitioners and physician assistants and other non-
 physician health care practitioners, yet existing state laws and
 regulations preclude these health care providers from practicing to the
 fullest extent possible.
     HB 1251 and HB 1252 -- Representative Readshaw - Physician's Assistants
 Adding a physician assistant to a medical practice can virtually double the
 number of patients seen at a much lower cost for the service at the same
 level of quality. Past legislation limited the number of physician's
 assistants with whom a physician might establish a collaborative agreement
 to two. House bills 1251 and 1252 expand that to four possible
 collaborative agreements.
     HB 1253 -- Representative Solobay -- Certified Registered Nurse
 Practitioners (CRNP)
     A CRNP while functioning in the expanded role as a professional nurse
 shall practice within the scope of practice of the particular clinical
 specialty area in which the nurse is certified. A CRNP may perform acts of
 medical diagnosis in collaboration with a physician and in accordance with
 regulations promulgated by the board.
     A certified registered nurse practitioner may now perform the following
     -- Order home hospice care.
     -- Order durable medical equipment.
     -- Issue oral orders to the extent permitted by the health care
        facilities' by-laws, rules, regulations or administrative policies and
     -- Make physical therapy and dietician referrals.
     -- Order respiratory or occupational therapy.
     -- Make respiratory and occupational therapy referrals.
     -- Perform Disability assessments for the program providing temporary
        assistance to needy families.
     -- Issue home bound schooling certifications.
     -- Perform and sign the initial assessment of methadone treatment
        evaluations, provided that any order for methadone treatment shall be
        made only by a physician.
     HB 1254 -- Representative Gibbons -- Clinical Nurse Specialists The
 legislation defines the role of a clinical nurse specialist including
 educational standards and training requirements for various fields.
 Furthermore by establishing a clear legal definition of clinical nurse
 specialists, the legislation provides protection both the patients and
     In addition the legislation requires clinical nurse specialists to
 carry the appropriate level of medical liability insurance for whatever
 practices they are engaged in.
     HB 1255 -- Representative Waters -- Nurse Midwives
     Pennsylvania was the only state in the Nation which did not allow nurse
 midwives any prescriptive power. Approximately 10 percent of all babies
 born in the state are birthed by nurse midwives. In many areas of the
 Commonwealth these specialized nurse practitioners are also the only source
 of pre-natal and gynecological care.
     The legislation allows nurse midwives with proper pharmacologic
 training to write prescriptions within a collaborative agreement with a
     SB 455 -- Senator Vance -- Dental Hygienists More than 1.5 million
 Pennsylvanians live in a federally designated dental health professional
 shortage area. In states with similar shortages, dental hygienists fill
 this void by providing routine dental care. Pennsylvania's licensing
 statute and regulations limit dental hygienists' independence and the
 functions they can perform.
     The legislation allows dental hygienists to perform specific functions
 without the direct supervision of a dentist in order to give them greater
 ability to provide basic dental hygiene services in a greater variety of
     Amy Kelchner, GOHCR

SOURCE Pennsylvania Office of the Governor