Quality Update for July 24, 2003

Consumers Views Mixed On Payment For Quality Efforts Five Kentucky Hospitals Join Anthem Payment For Quality Program Tenet Hospitals Sign On For Hospital Quality Initiative, Leapfrog Survey HHS Envisions National Policies Addressing Leading Chronic Diseases JCAHO Announces New Patient Safety Goals, Wrong-Site Surgery Protocol JCAHO Seeks Input On Revised Infection Control Standards ‘Wired’ Hospitals Report Commitment To Patient Safety, Quality Through IT Report Offers Guidance On Electronic Exchange Of Clinical Information HIMSS, AAFP Team Up On EMR Demonstration Project EHR Collaborativhe Sets Public Forums On Standardizing Health Records IG: Ombudsmen-Filed Nursing Home Complaints Rose 23% Over 4 Years Consumers Views Mixed On Payment For Quality Efforts As policymakers and insurers show increasing interest in rewarding providers for high quality care, a survey by Wall Street Journal and Harris Interactive indicates that consumers have mixed feelings about paying more for better performance. Specifically, the survey found many people support the idea of paying more for care at hospitals deemed to provide better services, as long as it’s not the patient who has to pay extra. Also, those earning more money are more willing to pay for better care. Below are excerpts from the online survey of 2,357 people between July 10-12: "Do you favor or oppose health insurance plans paying more to hospitals and medical groups which have been shown to provide better care, and paying less to those which have not?"   Total % Favor 44 Oppose 16 Not sure 40 "Do you think there are fair and reliable ways to measure and compare the quality of care provided by different hospitals and different medical groups?" Total % There are fair and reliable ways 58 There are not any fair and reliable ways 11 Not sure 31 For more info, www.wsj.com. Back to top Five Kentucky Hospitals Join Anthem Payment For Quality Program Five hospitals in the Jewish Hospital network have signed onto a program under which they can learn higher reimbursements from Anthem Blue Cross and Blue Shield if they rate well on performance measures. The agreement linking hospital reimbursements to quality measurements is the first of its kind in Kentucky. The contract runs through 2005. Anthem has introduced a similar program at 33 hospitals in Indiana and Ohio in the past year. Anthem officials said they plan to offer the feature to Kentucky hospitals as their contracts come up for renewal and Jewish Hospital was the first to take Anthem up on it. How much of a bonus could be awarded is unknown, but Anthem said hospitals don’t risk losing money by participating. Anthem hospitals already collect and report quality data under the insurer’s Hospital Quality Program, in which 346 Kentucky, Indiana and Ohio hospitals take part. Until recently the results weren’t linked to reimbursement levels. Instead, the reports were used by Anthem to compare hospitals and hold "best practices" seminars in which high-performing hospitals share their methods, Anthem officials said. Performance measures include clinical outcomes on surgical infections and heart care, patient satisfaction measures, and whether hospitals implement patient safety systems. For more info, www.anthem.com. Back to top Tenet Hospitals Sign On For Hospital Quality Initiative, Leapfrog Survey Tenet Healthcare Corporation has announced that more than 100 of its hospitals will join the voluntary hospital quality reporting initiative—operated by the American Hospital Association, Federation of American Hospitals, and Association of American Medical Colleges—and participate in a Leapfrog Group survey. The hospital quality initiative focuses on quality measures for heart attack, heart failure, and pneumonia. Initial quality information is expected to be available on the Web this fall. AHA officials said about 1,500 hospitals already have enrolled in the voluntary program, with more expected to sign on. AHA, and its partners, has informed enrolled hospitals that the initial display of hospitals’ performance data has been postponed from July to September to allow as many hospitals as possible to display their data in the initial release. In addition to the quality initiative, all Tenet hospitals will participate in a 2003 survey sponsored by the Leapfrog Group in which outcomes will be used to publicize ways to reduce medical errors and improve hospital safety, the hospital group also announced. AHA also reports that the Oklahoma Hospital Association and the Florida Hospital Association have joined the list of state hospital associations formally endorsing the voluntary Quality Initiative. The Kentucky Hospital Association also recently endorsed the initiative, AHA said, bringing to 34 the number of state associations officially endorsing the hospital-led effort. For more info, www.aha.org. Back to top HHS Envisions National Policies Addressing Leading Chronic Diseases HHS Secy. Thompson has announced plans to develop several national policies to address leading chronic diseases. Working in collaboration with the private sector, HHS Secretary Tommy G. Thompson will propose national efforts addressing chronic conditions associated with tobacco use, obesity, and asthma. Thompson said he plans to work with health insurance companies, the corporate sector, and the fast food and restaurant industry. U.S. Surgeon General Richard Carmona said it is vital that the United States curb its obesity rates, especially among its youth. Also, the Agency for Healthcare Research and Quality will conduct research aimed at helping insurance companies develop incentives to get their clients to follow healthy lifestyles, Thompson said. For more info, www.hhs.gov. Back to top JCAHO Announces New Patient Safety Goals, Wrong-Site Surgery Protocol The Joint Commission on Accreditation of Healthcare Organizations has unveiled its 2004 National Patient Safety Goals, as well as a "universal protocol" for preventing wrong site, wrong procedure, and wrong person surgery. The goals, approved by the JCAHO Board of Commissioners last week, continues all of the 2003 Goals and adds a new goal that will focus on reducing the risk of health care-acquired infections. The new goal requires compliance with current CDC hand-hygiene guidelines and management. Dennis S. O’Leary, M.D., president of JCAHO said his organization feels strongly that reduction of unanticipated deaths related to nosocomial infections must become a top priority for hospital and other health care organization leaders. For each of the National Patient Safety Goals, there are evidence-based requirements that set clear expectations for health care organizations to address specific types of errors. The 2003 requirement to "read back" verbal and telephone orders in order to confirm their accuracy has been expanded for 2004 to include the read-back of critical test results that are communicated verbally. Beginning Jan. 1, 2004, the nearly 17,000 JCAHO-accredited health care organizations will be evaluated for compliance with all relevant goals and requirements. JCAHO also approved a requirement for compliance with the wrong-site surgery protocol by all accredited organizations that provide surgical services, beginning on July 1, 2004. The universal protocol expands and integrates a series of existing requirements under the 2003 and 2004 National Patient Safety Goals. It is applicable to all operative and other invasive procedures. The principal components of the Universal Protocol include: the pre-operative verification process; marking of the operative site; taking a "time out" immediately before starting the procedure; and adaptation of the requirements to non-operating room settings, including bedside procedures. The Universal Protocol is the consensus product of a national Summit on Wrong Site Surgery convened last spring by JCAHO, the American Medical Association, the American Hospital Association, and others. Participants concluded that wrong site, wrong procedure, and wrong person surgery can be prevented and that a universal protocol is needed to help accomplish this goal. JCAHO said the protocol follows a three-week public comment period that generated more than 3,000 responses from surgeons, nurses and other health care professionals, which were overwhelmingly in support of the Universal Protocol. JCAHO said it plans to seek formal endorsement of the Universal Protocol from all of the organizations that participated in the Wrong Site Surgery Summit, as well as other professional leadership organizations having interest in this issue. For more info, www.jcaho.org. Back to top JCAHO Seeks Input On Revised Infection Control Standards The Joint Commission on Accreditation of Healthcare Organizations has released for field review proposed changes to strengthen standards to help prevent the occurrence of deadly nosocomial infections. The draft infection control standards for ambulatory care, behavioral health care, home care, hospital and long term care organizations are posted at www.jcaho.org. The deadline for feedback is Aug. 1, and full implementation of the modified standards is targeted for January 2005. JCAHO said an expert group of physicians, nurses, risk managers and other health care professionals helped JCAHO revise the standards. The 20-member group identified six principal areas of emphasis: Staffing and personnel issues. Adherence to national guidelines. Employee health. Data collection and analysis. Care of the environment and equipment and supplies. Evaluation of infection control programs. For more info, www.jcaho.org. Back to top ‘Wired’ Hospitals Report Commitment To Patient Safety, Quality Through IT According to the fifth survey of the 100 "Most Wired" hospitals, facilities continue introducing and enhancing information technology to improve safety and quality. Conducted by the Hospitals and Health Networks, the journal of the American Hospital Association, 404 organizations representing 1,128 hospitals responded to the survey, of which the high scorers joined the "100 Most Wired." Other hospitals were recognized for being "Most Improved" and "Most Wireless." "In the last year, the Most Wired have worked to maintain their lead over other hospitals in the development and use of technology, bringing Web-enabled patient education to the bedside, linking medical monitoring equipment directly into the patient record and providing a vast array of self-care resources over their public Web sites," said Alden Solovy, executive editor of Hospitals and Health Networks. Officials with McKesson Corp., which funded the survey, said that it’s encouraging that in a slow economy and facing rising health care costs, hospitals are still committed to making investments in technology to benefit patients. Nearly three-quarters of the top 100 hospitals are large urban-area hospitals connected to universities or government institutions. Also, responding hospitals devoted 18% of their budgets in 2003 to information technology, compared to 16% two years ago. For more info, www.hhnmag.com. Back to top Report Offers Guidance On Electronic Exchange Of Clinical Information An electronic network in Santa Barbara County that securely shares patient-specific information via the Internet promises to be financially self-sustaining and offers valuable lessons about promoting health information exchange elsewhere, according to a new report published by the California HealthCare Foundation (CHCF). The Santa Barbara County Care Data Exchange (SBCCDE), a public-private collaboration of health care providers operating on a pilot basis since earlier this year, can provide a net financial benefit to the participants by reducing labor and transaction costs associated with manual data handling, said CHCF, which supported the effort through a $10 million grant. It said savings would be greater than calculated if clinical efficiencies, fewer hospital admissions, fewer medical errors, and reduction of duplicate tests-were quantified. After health care leaders in Santa Barbara approached CHCF with a vision for creating a community-owned data exchange network, CHCF selected CareScience Inc., an Internet-based care management solutions company, to serve as the project manager and develop the technology in 1999. "The Care Data Exchange network seeks to improve the quality of health care in Santa Barbara County by making patient information-clinical reports, test results, radiology images, eligibility, and administrative data-readily available at the point of care to authorized users," said David Brailer, M.D., co-author of the report and the project’s principal investigator. Participants in the locally governed exchange, who share the information through secure peer-to-peer technology, include local hospitals, the regional health authority, county health department, medical clinics, and a radiology lab. Data shared over the network continues to reside on information systems belonging to participants and does not have to be placed in a central data warehouse. CHCF said several possibilities stemming from the Care Data Exchange exist for federal initiatives, including: Financial incentives to stimulate the development of electronic networks. Clear federal health care regulations to establish "safe harbors" that remove questions about legality. Operating standards and support organizations for health exchange networks. For more info, www.chcf.org/topics/view.cfm?itemID=21086. Back to top HIMSS, AAFP Team Up On EMR Demonstration Project The Healthcare Information and Management Systems Society (HIMSS) and the American Academy of Family Physicians (AAFP) announced plans to collaborate on a six-month demonstration project studying the implementation of an open application service provider (ASP) electronic health record in six to 10 small family physician practices across the United States. The open ASP system manages and delivers information to multiple users, such as the family practice offices in the demonstration, from a remote location across a wide network area. The demonstration will begin no later than November 1, 2003. In its affiliation with the AAFP, HIMSS will serve as EHR content expert and as a liaison with the corporate community for the Academy’s members, HIMSS officials said. AAFP said it has identified the need to address implementation of EHR systems in the offices of member physicians. The collaboration between the two organizations focuses on eliminating the obstacles that can prevent the adoption of the EHR in a medical practice setting, HIMSS said. Fopr more info, www.himss.org. Back to top EHR Collaborative Sets Public Forums On Standardizing Health Records The EHR Collaborative, a group of health care organizations working to advance the adoption of health care information standards, next month will hold public forums in six U.S. cities to gather feedback on a proposed national standard for electronic medical records. The National Alliance for Health Information Technology, a member of the collaborative, said the meetings are a rare opportunity for the people who regularly work with medical records to ensure draft standards lead to electronic medical records that function effectively within health care’s clinical, administrative and financial operations. The collaborative will provide a description of the standard, which was drafted by Health Level 7 at the request of HHS. The collaborative will synthesize input from the forums and present a response to HL7 and HHS. For more info, www.EHRCollaborative.org. Back to top IG: Ombudsmen-Filed Nursing Home Complaints Rose 23% Over 4 Years Complaints filed by nursing home ombudsmen increased 23% between 1996-2000, while the nature of the top complaints remained the same, HHS Office of Inspector General reported. Over the four years reviewed, complaints concerning staff turnover skyrocketed by 207%, although the actual number of staff turnover complaints ranked well below other categories, the IG said. The IG surveyed complaints filed by state ombudsmen working individually with nursing home residents and their families to address problems and improve care. In addition, ombudsmen are required to report complaints to states that in turn provide aggregate complaint data to the Administration on Aging, which oversees the national ombudsmen program. Complaint data are filed in the National Ombudsman Reporting System (NORS). Across all categories, complaints filed in NORS grew from 145,000 in 1996 to 186,000 in 2000. The highest volume of complaints concerned requests for assistance and accidents involving residents. Dramatic increases in complaints also were noted in a number of categories in which at least 1,000 complaints were filed in 2000. In addition to staff turnover, complaints concerning dehydration jumped nearly 98%, and those involving infection control rose 91%, the report said. On the positive side, physical abuse complaints showed the slowest growth at less than 1%, and ranked 11th in the total number of complaints by 2000. Abuse complaints peaked at 15,501 cases in 1998, but declined each following year by a total of 3%, the report stated. The IG cautioned that while NORS data tracks national and in-state trends in nursing home complaints, the data are not reliable in making state-by-state comparisons because of variations in reporting methods. For more info, www.oig.hhs.gov/oei/reports/oei-09-02-00160.pdf. Back to top

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