Quality Update for August 8, 2003

CMS’ Scully Accused Of Wrongfully Blocking Grant Funds To Researcher HHS Joins With AHA, AMA To Distribute Patient Safety Info OIG Details Inaccurate Info For 1/2 Of Physicians In CMS Registry Rep. Johnson’s Bill Would Promote Electronic Medical Records Medicare Hailed On 38th Anniversary Poll: Proposed Medicare Changes Not Registering With Americans JCAHO Will Ask Hospitals To Gather, Use More Performance Data In 2004 IOM Urges New Vaccine Program Texas’ New Medical Error Reports Law Takes Effect Sept. 1 NCQA's Quality Compass 2003 Includes Data From 267 Health Plans Population-Based Disease Mgmt. Could Improve Quality, Lower Costs GAO Brief Highlights Promising Approaches To Reduce Disparities Indian Health Disparities Persist CMS’ Scully Accused Of Wrongfully Blocking Grant Funds To Researcher Congress’ investigative arm said that CMS Administrator Thomas A. Scully "undermined the integrity" of Medicare’s contracting system by rejecting funds headed for a University of Wisconsin nursing home researcher. General Accounting Office investigators found that Scully canceled up to $1.6 million in new work for Wisconsin’s Center for Health Systems Research and Analysis (CHSRA) last September—the same day the funds had been approved by Medicare staff. In blocking the funds, Scully cited comments by the center’s director David Zimmerman, who had questioned measures used for the nursing home public reporting and quality initiative, GAO said. "There is no entitlement to government contracts—especially when you try to sandbag the agency you contract with," Scully wrote in an e-mail last fall to Zimmerman that was included in GAOs report. "If you want to continue to yank my chain, I will continue to disconnect you from this agency," Scully told Zimmerman in another email. GAO also said that Scully left aides with the impression that Zimmerman should receive no new contracts, and the center has received none since September—but a future assignment has been approved. Scully has not commented on the GAO report, but HHS issued a statement criticizing Zimmerman’s group for obstructing the nursing home initiative. "The center, due to the body of work it had performed over the years, had become part of the problem, not the solution," HHS said. HHS added Scully never instructed his staff to prevent CHSRA from receiving more government work, but acknowledged that aides may have been left with that impression. Sen. Charles Grassley (R-IA), chairman of the Finance Committee, condemned Scully’s actions in a letter to HHS Secy. Thompson, calling the dealings "an intolerable threat to the integrity of the procurement process." Back to top HHS Joins With AHA, AMA To Distribute Patient Safety Info HHS announced that it will work with the American Hospital Association and the American Medical Association to distribute patient safety information to health care providers and patients. HHS is working with the health care provider organizations to distribute a variety of outreach materials to providers and patients. Working with the hospital and medical associations, HHS will promote new posters and fact sheets called, "5 Steps to Safer Health Care." AMA and AHA are encouraging hospital leaders and physicians to display the materials in waiting rooms and exam rooms to encourage dialogue. "These 5 Steps to Safer Health Care can help improve communication among all members of the health care team—with the patient at the center of that team. Step one is particularly critical: ‘Ask questions if you have doubts or concerns.’ It sounds simple, but it’s essential," AMA President Donald J. Palmisano said. The materials will offer evidence-based, practical tips on the role that patients can play to help improve safety of the care they receive. Information featured in the materials includes suggestions that could help patients avoid errors related to prescription medicines, laboratory tests, and surgical procedures. The Agency for Healthcare Research and Quality worked with the Centers for Medicare and Medicaid Services, the Office of Personnel Management, and the Labor Department to develop the materials. For more info, www.ahrq.gov/consumer/5steps.htm. Back to top OIG Details Inaccurate Info For 1/2 Of Physicians In CMS Registry The Office of Inspector General found inaccurate information for about half of the providers in the Centers for Medicare and Medicaid Services’ registry of physician identification numbers. Information on the numbers is stored in a national database called the Unique Physician/Practitioner Identification Number System, or UPIN Registry. The study found that 52% of providers in the registry had inaccurate information in at least one of their practice setting records. The IG sampled 500 UPINs and then contacted providers for verification of the data. Nine percent of the providers could not be contacted by mail. Information that was most often inaccurate included: whether the provider is certified in his/her primary specialty, the provider’s secondary specialty, whether the provider is certified in his/her secondary specialty, and professional training. The study also found that 44% of PINs have never been used or are no longer used to bill Medicare. The report said unreliable information in the registry can limit CMS’ oversight functions. For instance, inaccurate UPIN data may jeopardize CMS’ ability to identify unusual billing activity, the report said. The IG recommended CMS correct the information, deactivate unused practice settings, have contractors review data periodically, and revise guidelines to help ensure accurate recordings. CMS has indicated that it is taking steps to correct inaccurate and incomplete information. For more info, http://oig.hhs.gov/oei/reports/oei-03-01-00380.pdf. Back to top Rep. Johnson’s Bill Would Promote Electronic Medical Records The chair of the Ways and Means health subcommittee has introduced legislation that could improve health care quality by supporting health care information systems on par with those used in other industries. The National Health Information Infrastructure Act of 2003, introduced by Rep. Nancy Johnson (R-CT), would pave the way for making electronic medical records commonplace among providers. The bill would promote standards that allow for building on available and developing technology like personal digital assistants, Johnson said. The system would make available to caregivers a patient’s complete and accurate medical record in real time, she added. A similar effort is under way in the Senate, where the Better HEALTH Act of 2003, would support development of IT standards. Johnson’s bill would starts in motion the development of information technology that is comprehensive and interoperable across the country, she said. Through a national health information infrastructure, patients also will be able to access their medical records and health information. Back to top Medicare Hailed On 38th Anniversary Key leaders of Congress joined Bush administration officials in saluting Medicare on its 38th birthday July 30, as President Bush called for the House and Senate to resolve differences in their Medicare reform bills that would provide prescription drug coverage for seniors. "My pen is ready. I’m ready to sign a good bill," Bush said at the White House, where HHS Secy. Thompson, Senate Majority Leader Bill Frist (R-TN), and Sen. Max Baucus (D-MT) joined him. Bush described Medicare as "one of the greatest, most compassionate legislative achievements of the 20th century." "Since 1965 every president and every Congress has had the responsibility to uphold the promise of Medicare. And we will uphold that promise. We will do our duty," Bush said. For more info, www.whitehouse.gov. Back to top Poll: Proposed Medicare Changes Not Registering With Americans Despite figuring to the be among the top issues in coming elections, a new Wall Street Journal/Harris Interactive poll found that most people have not even heard of the proposed changes. Just 47% of adults said they have seen, heard, or read about the proposal for a new drug benefit, according to the poll. However, seniors were more aware of the issues than younger people—21% of those aged 18-24 were familiar with the proposal, compared to 74% of those 65 and older. Those who were familiar with the proposed benefit changes weren’t impressed—51% said it would be better to oppose the current plan and push for a more generous drug benefit. Harris conducted the online poll of more than 2,200 people July 14-20. For more info, www.wsj.com. Back to top JCAHO Will Ask Hospitals To Gather, Use More Performance Data In 2004 The Joint Commission on Accreditation of Healthcare Organizations announced expanded performance measurement expectations will require accredited hospitals to begin collecting and using data on an additional set of core performance measures beginning in January 2004. The new requirement, approved last month by JCAHO, will increase the scope of hospital collection and reporting of performance measure data from two to three sets of core measures. Hospitals now choose from four core measure sets that address acute myocardial infarction, heart failure, community acquired pneumonia, and pregnancy and related conditions. "By focusing measurement efforts on the most common inpatient conditions, hospital data-driven improvement efforts will have the broadest possible impacts," said JCAHO President Dr. Dennis O’Leary. Core measures are part of the JCAHO’s ORYX initiative. In addition to the current core measures, JCAHO is developing new measure sets that address surgical infection prevention, ICU care, pain, and inpatient pediatric asthma. These measure sets are expected to become available incrementally over the next six to 24 months, JCAHO said. For more info, www.jcaho.org. Back to top IOM Urges New Vaccine Program The Institute of Medicine has recommended a new vaccine financing program involving a vaccine insurance mandate, subsidy, and voucher plan. The new system would replace existing government vaccine purchasing programs and would require that all public and private insurance plans include vaccine benefits, IOM said in its report, Financing Vaccines in the 21st Century: Assuring Access and Availability. The report urged the federal government to provide a subsidy to health plans and providers to reimburse their vaccine purchase costs and administration fees. The federal government also would provide vouchers for uninsured children and adults to support recommended immunizations from health care providers of their choice, it said. IOM said the new system is intended to resolve "tensions" between the social value of vaccines and the low revenues vaccination generates for providers, as well as the less attractive opportunities vaccine production offers for the pharmaceutical industry. The report also recommended changes to the Advisory Committee on Immunization Practices, which recommends vaccines. It called for a series of public meetings, a post-implementation evaluation study, and development of a research agenda to facilitate implementation of the recommended plan. For more info, www.iom.edu. Back to top Texas’ New Medical Error Reports Law Takes Effect Sept. 1 A new Texas law will require hospitals, psychiatric hospitals, and ambulatory surgical centers in the state to report certain medical errors to the state Department of Health as of Sept. 1. The law (HB 1614) also requires health care facilities to implement risk-reduction strategies and share their best practices and safety measures that are effective in improving patient safety. Medical errors must be summarized in an annual report that will be available to the public, the law said. The report will contain only the error and the number of occurrences. Within 45 days after a hospital becomes aware of the error, the facility must analyze what caused the error and develop an action plan that identifies strategies to reduce the risk of a similar event in the future. All information compiled by the Department of Health related to the medical error will remain confidential, the legislation said, and information in the report may not be admitted as evidence or disclosed in any civil, criminal, or administrative proceeding. For more info, www.capitol.state.tx.us. Back to top NCQA's Quality Compass 2003 Includes Data From 267 Health Plans Quality information from 267 health plans covering more than 61 million people is available from the National Committee for Quality Assurance, the accreditation group announced. Quality Compass 2003 is NCQA’s latest edition of its annual database of Health Plan Employer Data and Information Set (HEDIS) and accreditation information from health plans. The database features performance data and member satisfaction information from the health plans, NCQA said. In addition, NCQA said its Quality Compass includes a "dividend calculator" that allows employers to compare how specific health plans will affect worker absenteeism and productivity rates. NCQA also announced that it is launching several programs, including its core Managed Care Organization (MCO) accreditation program, as a Web-based interactive survey. NCQA said its Interactive Survey System (ISS) will change the way health care organizations are reviewed, making the process faster and more efficient while giving organizations rapid feedback. NCQA unveiled ISS in February 2002 with NCQA’s Disease Management Accreditation and Certification programs. NCQA also has issued its final 2004 standards and guidelines for the accreditation of MCOs on the ISS. Changes to the standards reflect NCQA’s increased emphasis on performance, the organization said. For more info, www.ncqa.org. Back to top Population-Based Disease Mgmt. Could Improve Quality, Lower Costs A new article in Health Affairs said that population-based disease management programs that target Medicare fee-for-service beneficiaries with costly chronic conditions could improve health outcomes and lower costs. However, such programs will face challenges in helping seniors with multiple illnesses navigate complex drug regimens. According to the article, written by Sandra Foote of the Health Insurance Reform Project at The George Washington University, Medicare now is testing disease management in several demonstration projects, but none is population-based—none identify potential participants through Medicare data and reward disease-management contractors for improvements in health status and savings for whole populations, rather than for individual patients. But the article said political support is growing for addressing widespread failings in chronic care, such as those underway by many private-sector payers. Private-sector plans have not, however, done many rigorous studies of their population-based disease management programs to determine whether they improve health outcomes or reduce costs, the article said. But controlled studies may work better in the Medicare fee-for-service population, the article said, because it is large and extremely stable. The article said a demonstration testing population-based disease management ideally would target beneficiaries who have high-cost diseases affecting broad segments of the Medicare population, such as congestive heart failure or diabetes. For more info, www.healthaffairs.org/WebExclusives/Foote_Web_Excl_073003.htm. Back to top GAO Brief Highlights Promising Approaches To Reduce Disparities The General Accounting Office said that identifying promising approaches to address racial and ethnic disparities in health care is difficult as many efforts only recently began, evaluations and data are limited, and information on the nonfinancial causes of health care disparities is incomplete. In a briefing paper requested by Senate Majority Leader Bill Frist (R-TN), GAO reported on promising approaches identified during research reviews and discussions with federal agencies such as the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and several others. The report recommended the federal government could pursue the following strategies to reduce disparities: Develop new demonstration projects in federal programs using the best available evidence to target areas of disparities and plan promising interventions. Expand current efforts in programs and demonstration projects such as CDC’s REACH 2010 community-based coalitions. Strengthen federal leadership on disparities, including prompt dissemination of information on successful interventions to reduce or eliminate health care disparities. Collect complete and accurate racial and ethnic health care data in national surveys to better understand and target efforts to reduce health care disparities through steps such as ensuring the inclusion of adequate numbers of minority participants. For more info, www.gao.gov/cgi-bin/getrpt?GAO-03-862R. Back to top Indian Health Disparities Persist American Indians and Alaska Natives suffer from high rates of disease and early death from diabetes and other conditions when compared to whites, according to Indian health officials. At a Centers for Disease Control and Prevention news conference on American Indian health, W. Craig Vanderwagen, acting chief medical officer for the federal Indian Health Service, said a number of factors, including poverty and access to care, contribute to the Indian health disparities. Improvements in sanitation, the control of infectious diseases, and the lowering of infant and maternal mortality rates have extended the lifespan of Native Americans from 51 years in 1940 to 71 in 1995, Vanderwagen said. But solving those problems has exposed other difficult health issues. For instance, diabetes rates have been rising among all groups, but the disease is more than twice as common among Native Americans as among adults in the whole population. For more info, www.cdc.gov. Back to top

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