Developments to Watch

Risks and Rewards on the Health Care Horizon

New report highlights areas of concern -- and possible improvements -- for hospital and health system risk managers.
By: | February 17, 2016 • 4 min read
Topics: ERM | Health Care

New developments in the health care arena will be the talk of hospital C-suites this year.

To kickstart those discussions, the nonprofit ECRI Institute published its “2016 Top 10 Hospital C-Suite Watch List.” The list includes a cross-section of technological advances and technology use issues likely to have the most impact on the industry in the coming year.

Some items on the watch list have the potential to significantly improve patient outcomes while reducing liability and litigation risks for health systems, while others highlight areas of concern for hospital and health system risk managers.

Mobile stroke units, topping ECRI’s list this year, are ambulance-like units that could significantly improve outcomes for stroke victims.


A key factor in stroke survival and recovery is whether the patient receives an injection of tissue plasminogen activator (tPA) soon after the onset of symptoms. In the traditional model of treatment, fewer than 7 percent receive tPA within the proscribed timeframe.

Mobile stroke units (MSUs) allow facilities to dispatch specific equipment and emergency personnel directly to suspected stroke victims. Only a handful of units are currently in operation, most of which are retrofitted ambulance vehicles equipped with CT scanners, tPA infusion lines, and telemedicine setups with broadband access, so that field personnel can connect with neurologists on-site for assessment.

TopCSuiteMSUs could be a game-changer for patient care, cutting time to administration of tPA by half, said Diane Robertson, ECRI’s director of Health Technology Assessment Information Services, at a media briefing in early February.

However, hospitals that invest in them will need to consider the cyber security of the connection, which could extend a facility’s cyber vulnerabilities far beyond its physical walls.

A dynamic change in the field of robotic surgery landed at No. 7 on ECRI’s list.

Numerous hospitals have robotic surgery equipment that is nearing the end of its useful life. But some facilities may want to press pause before making any decisions about new investments, said Robert Maliff, director of ECRI’s Applied Solutions Group.


That’s because new competitors are finally entering the market this year after a 15-year monopoly held by Intuitive Surgical and its da Vinci robot series.

At the same time, the list of procedures that can be performed robotically is growing, meaning that hospitals will need to evaluate the scope of their robotic surgery programs, and carefully weigh their needs, goals, risks and expected outcomes before making any decisions about capital investments.

The adoption of warm donor organ perfusion systems — No. 10 on the watch list — is being watched closely by many in the industry. More than two-thirds of donated organs are never used because the current process of harvesting, preserving and transporting organs can diminish the viability of organs for transplant.

By contrast, warm perfusion systems allow organs to continue functioning outside the body in an artificial environment that mimics the body. This allows physicians to verify the function of donated organs that might otherwise be deemed unsuitable without a means of assessment.

A warm perfusion system for lungs is currently available. A system for hearts is expected to be on the market early this year, with systems designed for other organs still in development.

The technology has the potential to double the number of lung and heart transplants, reported ECRI, but hospitals must ensure against the risk of overwhelming their transplant staff and transplant center infrastructure.

No. 5 on the watch list offers the potential for significant benefit for a much more modest investment.  Specially designed blue-violet LED light fixtures, recently introduced to the market as Indigo-Clean, have the potential to sharply reduce the presence of bacteria that causes hospital-acquired infections (HAIs).

According to the CDC, about 2 million HAIs occur annually, resulting in 100,000 deaths and $28 billion to $45 billion in excess health care costs.  Hospitals that fall into the lowest quartile, based on HAI rates, are penalized by the Centers for Medicare & Medicaid Services.

Current disinfection methods are reasonably effective, said Linda Gross, clinical writer for ECRI’s Health Technology Assessment Information Systems, but bacteria levels begin to rise again as soon as the disinfection treatment ends. And some current methods can’t be used in occupied rooms because of the potential for hazardous exposure.


Blue-violet LED fixtures are designed to provide continuous disinfection, and pose no risks to occupants. Their use is not yet widespread, but early studies are overwhelmingly positive.

One study in a non-surgical setting measured a 90 percent reduction in surface bacteria in unoccupied rooms, and a 56 percent to 86 percent reduction in rooms occupied by a MRSA-infected patient.

In another study conducted in a patient-occupied intensive care unit, bacterial counts were reduced by up to 67 percent.

ECRI’s complete report is available online. Other items rounding out the list this year are wireless wearable sensors, miniature leadless pacemakers and new high-cost cardiovascular drugs.


Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]