Quality Update for December 3, 2004

U.S. Health Care Gets C+ For Patient Safety Kaiser Study Projects Benefits Under Prescription Drug Benefit Benefits Up to 83% VistA Trade Association Forms JCAHO Establishes National P4P Principles Certification Commission for HIT Names Work Group Chairs, Members U.S. Health Care Gets C+ For Patient Safety A Health Affairs report said that the United States has made “insufficient” progress improving the safety of patients in hospitals and gives the U.S. health system an overall grade of C+ on patient safety, noting some improvement but considerable deficiencies in key categories. Dr. Robert Wachter MD, associate chair of the Department of Medicine, University of California , San Francisco and editor of an online patient safety journal and book, conducted the report, which was supported by the Commonwealth Fund and released as a Health Affairs online exclusive. Wachter gives high marks to the effects of strong regulation and broader use of information technology. But he says that error reporting systems have had little impact on fostering patient safety and that there has been virtually no progress on making clinicians or health care systems more accountable for their actions over the past five years. For more info, “The End of the Beginning: Patient Safety Five Years after ‘To Err Is Human’,” can be obtained at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.534. Back to top Kaiser Study Projects Benefits Under Prescription Drug Benefit Benefits Up to 83% Low-income people with Medicare who sign up for new Part D drug plans and receive the additional subsidies – an estimated 8.7 million people – are projected to pay 83% less for prescription drugs in 2006 than they would have spent if the Medicare drug law had not been enacted, according to a report released by the Kaiser Family Foundation. Those who enroll in the new drug benefit but do not receive the low-income subsidies – an estimated 20.3 million people -- are projected to pay on average 28% less out of pocket for their prescription drugs as a result of the new law, the analysis finds. The report, based on a model developed by Actuarial Research Corporation (ARC) for the Foundation, estimates out-of-pocket drug spending in 2006 among the 29 million people that the Congressional Budget Office (CBO) expects will sign up for Medicare drug plans. “This analysis shows that the prescription drug law will provide the most help to seniors with low incomes and very high drug bills, just as Congress intended,” Foundation President Drew Altman, Ph.D., said. “Congress faced budget constraints and had to make tradeoff decisions; the question is whether the law they passed will meet seniors’ expectations.” The simulation model generally conforms to CBO’s assumptions and projections about Medicare drug benefit spending and participation rates for the new benefit, known as Medicare Part D, and for the low-income subsidy. The projections of out-of-pocket drug spending are based on the likely response of Medicare beneficiaries to the new law. They do not reflect the effects of supplemental coverage that beneficiaries might obtain or take into account premiums paid by beneficiaries, which are estimated by CBO to average $420 for the new Medicare benefit in 2006. For more info, www.kff.org/medicare/med112204pkg.cfm. Back to top VistA Trade Association Forms A trade association has been formed to speed the adoption of electronic health records (EHR) in private sector health care organizations. VistA Software Alliance, will be promoting VistA , a health care management system originally developed by the Veterans Administration (VA) for use in its hospitals and clinics. The software has also been used in other federal agencies and by other health care systems in the U.S. and throughout the world. The VA and the Centers for Medicare and Medicaid Services ( CMS ) plan to release a version of VistA tailored to medical practices in mid-2005. The new software, VistAOffice EHR, will be released into the public domain. "In order to realize the benefits of EHRs, hospitals and medical practices need a system that is fully functional and affordable," said Barbara Boykin, chairman of the VistA Software Alliance. " VistA offers a unique combination of affordability with proven electronic health record technology. VistA and VistAOffice EHR will allow more health care organizations to utilize electronic health records to improve quality, lower costs, and decrease patient errors." The organization is initially governed by a nine-member board of directors, and a three-member executive committee. The founding board members represent Document Storage Systems, Inc., Hewlett-Packard Company, InterSystems Corporation, Medical Alliances, Inc., Medsphere Systems Corporation, Oleen Healthcare Information Management, Inc., Perot Systems Corporation and Sea Island Systems. For more info, www.VistASoftware.org. Back to top JCAHO Establishes National P4P Principles The Joint Commission on Accreditation of Healthcare Organizations released a set of principles to guide the development and refinement of health care pay for performance programs. The Joint Commission's Board of Commissioners emphasized that pay-for-performance programs must place the highest priority on patient-centered efforts to improve health care quality and patient safety. The principles are designed for use by policymakers, third-party payers, health plans, purchasers, and others who are involved in programs that provide incentives for achieving performance benchmarks. While more than 100 pay-for-performance programs currently exist nationwide, few of these programs are guided by explicit principles that articulate overarching goals. As one of the nation's foremost advocates for health care quality and patient safety, the Joint Commission is urging that new models pay specific attention to aligning incentives among patients, practitioners, provider organizations, purchasers, and payers. "We are truly at a crossroads in determining the future direction of health care," JCAHO President Dr. Dennis S. O'Leary said. "The thoughtful design of pay-for-performance programs and ongoing efforts to evaluate their effectiveness should eventually provide the bases for understanding how best to use financial and other incentives to leverage continuous improvement in the safety and quality of care." For more info, http://www.jcaho.org/news+room/news+release+archives/jcaho_112204_principles.htm. Back to top Certification Commission for HIT Names Work Group Chairs, Members The Certification Commission for Healthcare Information Technology has appointed co-chairs and members for four work groups. About 270 people from all sectors of health care applied to join the work groups, which will draft the initial certification requirements and procedures to support a pilot of the certification process by the summer of 2005. In choosing the work group members, the commission selected participants with extensive health care industry experience, practical experience in implementing health information technology ( HIT ) and/or EHRs and previous contribution to a large industry work group, committee or standards projects. CCHIT named eight to 10 members and two cochairs for each of four EHR work groups: Functionality – setting features and functions to meet an initial set of requirements. Co-chairs: Dr. Sarah Corley, governor of the Virginia Chapter, American College of Physicians, and Rick Skinner, vice president and chief information officer of Providence Health System. Security and Reliability – ensuring data privacy and robustness to prevent data loss Co-chairs: Solomon Appavu, director systems planning, John H. Stroger, Jr. Hospital & Cook County Bureau of Health Services, and Mariann Yeager, principal of Emerson Strategic Group, Inc. Interoperability – enabling standards-based data exchange with other sources of health care information Co-chairs: Peter DeVault, director of enterprise integration and interoperability of Epic Systems Corp., and Dr. Carol Diamond, managing director of the Markle Foundation. Certification Process – determining how vendors will apply for certification, who and how testing for compliance will be handled, and how the database of certified products will be maintained and publicized. Co-chairs: Dr. Steve Arnold, senior medical director of AmeriChoice, and Michael Kappel, senior vice president of government relations of McKesson Corp. For more info, www.cchit.org. Back to top

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