Quality Update for November 14, 2003

Health Care Leaders: Medicare Should Lead Pay For Performance New Report Shows Heart Patients Aren’t Getting Appropriate Care Study: Seniors Get Recommended Care Only About Half The Time CMS Begins Reporting Home Health Quality Measures On Internet AAFP Inks Deal With Companies To Help Boost E-Health Record Use GAO Report: Health IT Projects Improve Quality, Cut Costs AHRQ Awards $4M In Patient Safety Grants RWJF Offers Fellowships For Executive Nurse Program Health Care Leaders: Medicare Should Lead Pay For Performance In an open letter published in the November/December issue of Health Affairs, leading health care policy experts acknowledged the significant steps recently taken by the Centers for Medicare and Medicaid Services to improve quality, and urged the agency to pay Medicare providers based on their performance on quality indicators. The letter was signed by former CMS administrators such as Nancy-Ann DeParle, William Roper, and Gail Wilensky, as well as experts such as the Institute for Healthcare Improvement’s Donald Berwick, the National Quality Forum’s Kenneth Kizer, health services researcher John Wennberg, among others. The letter noted that, “a unique opportunity now exists to address the crisis of quality facing the nation’s health system.” It said paying for performance, which is “a bedrock principle in most industries,” should be expanded in health care. The letter said that improved health systems that reduce errors and reinforce best practices are needed, but are unlikely to spread without strong financial incentives. “As the biggest purchaser in the system, the Medicare program should take the lead in this regard. Decisive change will occur only when Medicare, with the full support of the administration and Congress, creates financial incentives that promote pursuit of improved quality,” the letter said. The letter noted that CMS has taken “significant steps toward a quality strategy based on quality measurement and incentives.” The letter highlighted the agency’s publication of performance data on nursing homes and home health agencies and its demonstration project with Premier Inc. to pay quality-improvement incentive bonuses for Medicare patients at participating institutions. “Our recommendation—to the executive branch; to Congress; to employers and health plans; and to hospitals, physicians, nurses, and other health professionals—is that payment for performance should become a top national priority and that Medicare payments should lead in this effort, with an immediate priority for hospital care,” the letter said. It also urged that future CMS administrators follow Thomas Scully’s lead and “assure that quality improvement becomes a priority throughout the agency, year in and year out.” For more info, www.healthaffairs.org. Back to top New Report Shows Heart Patients Aren’t Getting Appropriate Care Despite general recognition that ACE inhibitor drugs are often a recommended treatment for congestive heart failure, a new survey has revealed that nearly one-third of patients leave the hospital without receiving the drugs. In a recent study, Dr. Gregg Fonarow of the University of California, Los Angeles, looked at how often patients hospitalized with heart failure are discharged with four standard kinds of care, including ACE inhibitors at patient discharge; discharges without a complete set of instructions; smoking cessation counseling; and a measure of the left ventricle pumping power. “There are certain hospitals in the United States where 100% of the patients get this,” Dr. Fonarow told the Associated Press. “There are others where patients had a better chance of winning the lottery than getting the indicated care.” The survey found that 31% of patients considered ideal candidates for ACE inhibitors are sent home without them. Even at elite teaching hospitals affiliated with medical schools, more than one-quarter did not receive the drugs, the survey said. The report also found that 72% of patients were discharged without receiving a complete set of recommended discharge instructions; 69% of smokers with heart failure were never told to quit; and 18% of patients did not receive a measure of their left ventricles ejection function, which is a standard indicator of heart failure. The report analyzed discharge data on 54,639 heart failure patients at 260 hospitals between October 2001-January 2003. The data was presented recently at the American Heart Association’s Annual Scientific Meeting in Orlando, FL. For more info, www.bestofsessions.org. Back to top Study: Seniors Get Recommended Care Only About Half The Time Older Americans with health problems get the recommended medical care they need only half the time, according to a new study published in the Nov. 4 Annals of Internal Medicine. The report found that seniors got the recommended care for general medical conditions like heart disease just 52% of the time. But the figures worsened when researchers focused in on age-related diseases such as dementia or malnutrition, for which seniors got the appropriate care about one-third of the time. Researchers from RAND Health looked at the medical records for 372 frail seniors who had been treated by two managed-care organizations over the course of a year. They documented the medical care that each patient received and then judged it using standard indicators of quality. The study indicated that some doctors and other health care providers may overlook common problems of old age. For instance, the report said that many seniors with an unsteady gait don’t get the help they need, like physical therapy to improve their walking ability and avoid falling. Responding to a report in a USA Today article, Dr. Yank Coble, of the American Medical Association said the study was too small of a sample. He added that lots of factors go into health care quality, including the amount of time doctors have available to treat patients. He said many doctors face a major time-crunch that doesn’t allow them to focus on more than the most pressing medical problem of the visit. For more info, www.annals.org. Back to top CMS Begins Reporting Home Health Quality Measures On Internet Consumers can now access quality data about home health agencies across the country via the Home Health Compare Web site, the latest tool in the Centers for Medicare and Medicaid Services’ effort to report provider quality data and use Quality Improvement Organizations (QIOs) to improve care. The home health quality initiative, which follows the nursing home quality initiative launched 2002, uses home health agency data to compare agencies in each state. Home Health Compare reports on 11 quality measures, a subset of the Outcomes and Assessment Information Set (OASIS) data that home health agencies regularly send to CMS. Advertisements with a sample of the quality data available on Home Health Compare ran Nov. 4 in 69 newspapers across the country. The ads, designed to alert consumers to information available on the Web site, listed three of the 11 quality measures CMS is using to compare home health agencies to others in their respective states. The home health quality initiative began as an eight-state pilot project in February, and CMS said half the HHAs in those states sought assistance from QIOs in improving care. In addition, CMS reports that QIOs have trained over 5000 home health agencies in quality improvement techniques over the past year. For more info, www.ahqa.org/briefing. Back to top AAFP Inks Deal With Companies To Help Boost E-Health Record Use The American Academy of Family Physicians has announced a strategic business alliance to remove barriers standing in the way of electronic health record (EHR) technology use in medical practices. The deal includes A4 Health Systems, Inc.; GE Medical Systems Information Technologies; HP; MedPlexus, Inc.; MedPlus, Inc.; NextGen Healthcare Information Systems, Inc.; Physician Micro Systems, Inc.; Siemens Medical Solutions Health Services Corporation; and Welch Allyn, Inc. The EHR systems the AAFP and its partners are developing will help ensure patients receive the timeliest, appropriate and efficient medical care possible, AAFP said. Under the agreement: A4 Health Systems, Inc. will provide discounted EHR and practice management packages to AAFP members; GE Medical Systems Information Technologies will offer AAFP members cost-effective physician office EHR software solutions; HP will offer AAFP members discounts on technology and resources through a Web site specially configured for AAFP; MedPlexus is working closely with the AAFP to improve features and functionality of the EHR system and will provide discounted software and services to AAFP members. MedPlus, Inc. will offer discounted interface software and data management services to AAFP members. NextGen will provide discounts on EHR and practice management packages to AAFP members. Physician Micro Systems, Inc. will offer AAFP members discounted EHR and practice management software packages. Siemens will assist the AAFP with engineering expertise and managed hosting. And Welch Allyn, Inc. will provide medical devices for electronic measuring and transfer of patient data and interface software to AAFP members. AAFP said four basic principles will guide these strategic alliance, including affordability, compatibility, interoperability, and data stewardship and protection. For more info, www.aafp.org. Back to top GAO Report: Health IT Projects Improve Quality, Cut Costs The General Accounting Office has released a report examining IT initiatives at 10 health care providers across the nation and found improvement in care, as well as cost benefits from fewer medication errors, better communication, documentation and staffing, and other improvements. The report, requested by the Senate Health Committee to identify cost savings and benefits of implementing IT in clinical settings, also includes examples of three insurers’ IT efforts and a community data network for exchanging health care information. Among the provider initiatives included in the report is the bar code medication system used by Danville Regional Medical Center in Danville, N.C., as part of its electronic medical records. In 2002, the system prevented 3,209 medication errors saving nearly $850,000, the report said. In addition, Geisinger Medical Center in Danville, Penn., has used an outpatient EMR system for its 2.4 million patients, complete with direct order entry for laboratory and radiology orders. The system has increased productivity, reduced transcription costs by 50% or more in some departments and saved $1,000 per physician per year due to improved formulary compliance, it said. The report also looks at IT efforts at the Mayo Clinic, Boston’s Partners HealthCare, the Departments of Defense and Veterans Affairs, Kaiser Permanente Northwest, Vanderbilt University Medical Center in Nashville, Tenn., and St. Vincent’s Hospital in Birmingham, Ala. For more info, www.gao.gov. Back to top AHRQ Awards $4M In Patient Safety Grants In addition to co-hosting a national summit designed to update the research agenda on patient safety, the Agency for Healthcare Research and Quality has announced the award of almost $4 million to fund 13 projects designed to improve patient safety. The Quality Interagency Coordinating Task Force, which includes AHRQ, CMS, and other federal agencies last week held the 2nd National Summit on Patient Safety Research in Arlington, VA, which was attended by numerous AHRQ patient safety grantees, health services researchers, and several QIO representatives. The summit featured panels on topics such as epidemiology of patient safety risks, effective practices to reduce errors, and monitoring progress on patient safety. Six of the new AHRQ patient safety grants announced last week will assess patient safety risks to patients and devise ways to prevent them; the remaining seven will implement safe practices that show evidence of eliminating or reducing known hazards to patient safety. The 13 grants build on AHRQ’s 3-year, $165 million investment in patient safety research. AHRQ currently supports 100 other research projects that comprise an extensive, user-driven research agenda designed to improve patient safety and enhance quality of care, the agency said. AHRQ will provide up to 50% of the total cost of the projects, while grant recipients will be required to provide a minimum of 50% of the total costs. AHRQ announced the cooperative agreements in tandem with its Patient Safety Task Force, established by Secretary Thompson to coordinate research efforts across HHS. The Task Force is composed of AHRQ, the Centers for Disease Control and Prevention, CMS, and the Food and Drug Administration. For more info, www.ahrq.gov. Back to top RWJF Offers Fellowships For Executive Nurse Program The Robert Wood Johnson Foundation is offering three-year fellowships for nurses in senior executive roles in health services, public health, and nursing education to help them lead and shape the health care system. The fellowships allow recipients to stay in their current positions and help participants gain the experiences, insights and skills necessary to advance in executive leadership positions. The program is designed to increase the influence of nurses and nursing across the economy. Up to 20 fellowships will be awarded in 2004, and are due Jan. 30, 2004. For more info, www.rwjf.org/cfp/executive nurse fellows. Back to top