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Medicare
Commission Recommends Quality Payment Incentives Senator
Clinton Proposes Health Legislation With Focus on Quality IOM
Report Calls for Universal Health Care by 2010 Study:
Greater Use of Beta Blockers Lowers Medicare Costs Volume
May Not Be Best Quality Indicator, Studies Find Task
Force Finds Informed Decision Making Works IT
Aids Evidence-Based Practices American
College of Physicians Report Calls For More IT New
Website to Help Patients Improve Quality of Care WellPoint
To Invest $30M in Physician Computers Physicians
Like IT But Slow to Adopt, Surveys Find Medicare
Commission Recommends Quality Payment Incentives The Medicare
Payment Advisory Commission voted this month to recommend creating payment
incentives to reward health care providers who deliver higher quality
care in Medicare’s managed care plans and dialysis facilities. MedPAC Chair
Glenn M. Hackbarth said the commission hopes quality incentive payments
eventually will be used throughout the entire Medicare program. If approved,
the quality payments would not add to the aggregate sum paid by Medicare
but would be paid out of the money in a payment pool for quality incentives.
MedPAC research director Scott Harrison said the payment plan would earmark
a small percentage to distribute based on performance. MedPAC noted
that the current Medicare+Choice payment system is neutral or negative
toward quality and fails to reward plans or providers who are seeking
to improve the quality of health care. In June 2003,
MedPAC recommended that Medicare as a whole pursue a provider or plan
payment designed to improve quality. “Quality in the M+C program
may improve in response to the establishment of incentive payments,”
MedPAC staff recently stated. For more
info, www.medpac.gov. Senator
Clinton Proposes Health Legislation With Focus on Quality Sen. Hillary
Rodham Clinton (D-NY) introduced the Health Care Quality Improvement Act
on Jan. 12, which would create a national electronic health record system,
provide a public reporting system on quality of care and move to a pay-per-performance
system. “In
spite of the best intentions of clinicians and patients, our health care
system is plagued with underuse, overuse and misuse stemming from the
complexity, duplication and bureaucracy of our health care delivery system,”
Clinton said. The legislation
as outlined by Clinton’s office has five main points: Increase research
on quality of care; Provide the public with a standardized reporting system
that allows consumers to reliably compare performance; Build an information
technology infrastructure that enables information sharing; Give patients
and providers information in real time; and pay for performance For more
info, http://clinton.senate.gov. Nursing
Home Data Now Easier to Compare The Medicare
Nursing Home Compare website has developed enhanced measures and other
upgrades designed to compare the quality of care provided in nursing homes
Upgrades
to Nursing Home Compare make it more user-friendly and easier to navigate.
Consumers can now search by distance from a city or ZIP code and by nursing
home name, and print maps and directions for the nursing homes they select.
The website is also available in Spanish. Nursing Home
Compare and the quality measures are part of the Nursing Home Quality
Initiative (NHQI), launched in 2002 by the Centers for Medicare &
Medicaid Services (CMS), an agency of the U.S. Department of Health and
Human Services. The Initiative demonstrates CMS's ongoing commitment to
improve quality of care through accountability and public disclosure.
The 14 enhanced
quality measures, including 11 for chronic and three for post-acute care,
are endorsed by the National Quality Forum (NQF), a voluntary standard-setting
consensus-building organization representing providers, consumers, purchasers
and researchers. Medicare worked with the NQF to endorse measures that
reflect issues of importance to consumers when they make decisions about
nursing home care. The NQF reviewed
existing research to ensure that the selected quality measures employ
the best science available and validly reflect quality of care. The enhanced
measure set reflects the recent recommendations by the NQF. For more
info, , www.medicare.gov, and click
on the Nursing Home Compare link. IOM
Report Calls for Universal Health Care by 2010 The Institute
of Medicine has issued a report calling for the president and Congress
to implement universal health coverage by 2010. The 16-member
IOM committee outlined five guiding principles by which all proposals
for extending coverage should be judged: Health care coverage should be
universal; Health care coverage should be continuous; Health care coverage
should be affordable to individuals and families; The health insurance
strategy should be affordable for our society; and Health care coverage
should enhance health and well-being by promoting access to high-quality
care that is effective, efficient, safe, timely, patient-centered, and
equitable. For more
info, www.iom.edu/report.asp?id=17632. Study:
Greater Use of Beta Blockers Lowers Medicare Costs Researchers
at the Duke Center for Education and Research Therapeutics have conducted
a study concluding that Medicare costs would decrease if the use of beta-blocker
drugs were more widespread. The study,
“Economic Effects of Beta Blocker Therapy in Patients with Heart
Failure,” is published in the January issue of American Journal
of Medicine. Sponsored
by the Agency for Healthcare Research and Quality, researchers estimated
that treatment for heart failure without beta-blocker drugs would cost
Medicare an estimated $39,739 per-patient over a five-year period. However,
treatment with beta-blockers would cost an estimated $33,675—a per-patient
savings of $6,064. In contrast,
beta-blocker therapy would increase expenses to Medicare patients by an
estimated $2,113 over five years. Clinical
trials have demonstrated the effectiveness of beta-blockers in reducing
hospitalizations and deaths from heart failure. For more
info, www.ahrq.gov. Volume
May Not Be Best Quality Indicator, Studies Find Two studies
in the Jan. 14 edition of Journal of the American Medical Association
indicate that surgical volume may not be an adequate quality measure.
In recent years, surgical volume has been promoted as a way to judge quality
by organizations such as the Leapfrog Group. The first
study, led by Dr. Eric D. Peterson of Duke University found that in contemporary
practice, hospital procedural volume is only modestly associated with
coronary artery bypass graft (CABG) outcomes. Researchers concluded that
volume therefore may not be an adequate quality metric for CABG surgery.
To conduct
the study, researchers looked at 267,089 CABG cases in 439 hospitals in
2000 and 2001. In patients
65 years and older, there was a 1% different in observed mortality rates
between low and high-volume hospitals. For patients younger than 65 years,
observed mortality rates declined by 0.3%. A separate
study published in the same edition of JAMA examined mortality
rates for very low birth weight infants, and found that past experience
may be a better indicator than patient volume. That study
looked at 94,100 low-birth weight infants born at 332 hospitals between
Jan. 1, 1995 and Dec. 31, 2000. Researchers found that historical volume
was not significant in relation to mortality rates between 1999-2000.
However, hospitals that had the lowest mortality rates between 1995-1998
had significantly lower mortality rates between 1999-2000. For more
info, http://jama.ama-assn.org. Task
Force Finds Informed Decision Making Works A CDC task
force on preventive medicine found consistent evidence that informed decision-making
interventions can improve patient knowledge about cancer screening tests
and the risks and benefits associated with screening. However,
there was not enough evidence to show the extent to which these interventions
helped patients at the level they desired. The Task
Force on Community Preventive Services conducted a systematic review of
published studies covering population-based interventions designed to
improve informed decision making for cancer screening. Researchers
found that there was generally consistent evidence that informed decision
making improved knowledge, beliefs, risk perceptions or a combination
thereof. Resources such as the Internet and brochures were cited as tools
in helping patients make good decisions. For more
info, www.thecommunityguide.org.
IT
Aids Evidence-Based Practices Physicians
are increasingly using technology to sort information about evidence-based
medicine and customize this information for their health care practices,
according to an article in Health Data Management. Experts said
using technology such as handheld devices, can help physicians sort through
mountains of information to improve patient safety. It may also become
part of the reimbursement process, especially with Medicare pilot programs
that already base full payment on provider track records in following
best practices. Dr. David
Trace, strategic director at of an IT health care consulting firm, The
Kennedy Group, said these findings indicate a shift in the health care
industry from focusing on costs back to quality-based medicine. “In
the last decade there was a focus on health care cost,” Trace said
in the article. “Now it’s on quality and we’re seeing
greater interest in evidence-based medicine. It’s driven by the
notion that people need to understand quality as they watch the health
care dollar. Everyone is looking for value, and value is quality divided
by cost.” American
College of Physicians Report Calls For More IT The American
College of Physicians called for better use of health IT in its annual
State of the Nation’s Health Care, a four-part report used as the
society’s legislative guide. “Congress
and the administration should provide the resources and policy framework
needed to encourage an expeditious but voluntary transition from paper-based
systems to patient- and physician-friendly computer-based information
technologies to improve patient care,” the report states. The report
called on Congress and the Bush administration to support the health care
industry’s efforts to adopt electronic health records, and develop
the framework that would overcome barriers to the transition. “Specifically,
the federal government should provide resources to make it affordable
for practitioners to acquire the necessary technologies (including direct
payment for physicians’ front-end expenses and lost time in operating
mixed systems), provide opportunities for physicians to share in the system-wide
savings from information technology, and support the development and testing
of standards to resolve interoperability and connectivity issues,”
the report argued. However,
ACP contends that the IT move should be voluntary and not mandatory. For more
info, www.acponline.org. New
Website to Help Patients Improve Quality of Care A new interactive
website launched on January 12 and funded by a grant from the National
Institutes of Health is designed to allow patients to improve the quality
of their health care. The website,
www.myexpertdoctor.com, gives
patients personalized feedback and a list of questions to take to their
next doctor visit. Before a
doctor visit, patients use the website to complete a brief survey about
their health, the care that they’ve received in the past and the
list of medications that they take. Based on their answers and the work
of the site’s medical experts, each patient who uses the website
receives personalized feedback about his or her health, the quality of
the care they are receiving, and a list of questions to ask their doctor
on their next visit. Dr. Christopher
Sciamanna, a Brown University physician who specializes in the use of
computers to improve health care quality, developed the website. For more
info, www.myexpertdoctor.com. WellPoint
To Invest $30M in Physician Computers WellPoint
Health Networks Inc. announced plans to give 20% of its network physicians
either a computer system to automate claims administration or a hand-held
device to facilitate electronic prescriptions for patients. The purchase
is valued at $30 million, about $1,600 for each of 19,000 physicians in
California, Georgia, Missouri and Wisconsin. The offer is limited to physicians
who treat the largest number of WellPoint’s medical members. However,
all of the company’s 176,000 network physicians will be able to
purchase the equipment at a discounted price. In launching
the initiative, WellPoint cited studies by the Institute of Medicine reporting
that more than 7,000 deaths and as many as 7% of hospital admissions occur
as a result of adverse drug effects and medication errors. The study
called for computerized physician-order-entry systems for prescriptions,
which the IOM said could reduce errors. The computer
systems that WellPoint is offering will also help doctors use the Internet
to submit claims faster and receive reimbursements quicker. For more
info, www.wellpoint.com. Physicians
Like IT But Slow to Adopt, Surveys Find Two surveys
found that doctors are slow to use information technology, even though
most physicians believe that it is becoming an essential part of the clinical
practice. The Massachusetts
Medical Society surveyed 423 physicians who believe that technology is
an essential part of clinical care and can improve patient safety, but
have no intention of adopting IT at this time. A different
survey found that less than 10% of hospitals in the U.S. have made computerized
physician order entry completely available to physicians throughout their
facilities. Cost and time are generally cited as the major inhibitors
to moving to IT in the clinical practice. For more
info, www.ama-assn.org/amednews/2004/01/19/bisb0119.htm.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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