Quality Update For February 2, 2005

NQF Adds Health Care Technology Section Federal Funding Restored For HIT Projects More Physician Practices Adopt EMRs Many Physicians Doubt Error-Reduction Interventions Tech Companies Agree On HIT Standards ACP Calls for HIT Incentives MedPAC Chief Says Medicare Should Reward Quality Gains Critical Care Nurses: Silence Kills JCAHO Launches “Speak Up” Campaign New Briefing Book on Medicare/Medicaid Coalition Proposes Apologies and Cash for Medical Errors Survey Shows Safer Medication Practices Spreading Physician Groups Seek To Cut Health Care Disparities NQF to Hold P4P Conference Ranks of Hospitalists Growing Better Teamwork for Safer Care NQF Adds Health Care Technology Section In addition to its existing four member councils, the National Quality Forum has convened a Healthcare Technology Section to provide a forum for discussion and networking by technology-related organizations. The section will also address issues of interest to technology-related companies, facilitate the integration of technology in healthcare quality improvement activities, and assume an active role in NQF membership. The NQF's Healthcare Technology Section will include representatives of information technology companies and IT membership organizations, medical device manufacturers, pharmaceutical companies, hospital equipment and durable medical equipment suppliers, and other technology-related vendors. “We don't have that many of the technology-related companies" as members, said NQF's President and Chief Executive Officer Kenneth Kizer, M.D. "They play an important role in improving quality.” Kizer said the output of electronic health record systems should be integral to performance measurement, and so vendors of EHRs and developers of quality metrics like the NQF “should be closely aligned because they have to populate their software with the stuff we want them to put out.” The section will have a liaison seat on NQF’s board of directors. For more information: www.qualityforum.org. Back to top Federal Funding Restored For HIT Projects President Bush recently announced a budget reshuffle aimed at restoring funding for the Office of the National Coordinator of Health Information Technology headed by Dr. David Brailer. Late last year Congress failed to approve $50 million for the HIT office, setting off speculation about the extent of the president’s commitment to Brailer and to HIT. Brailer said the $50 million this year will come from transfers of funds already appropriated in the HHS budget. “We're respectful of Congress and the appropriations process, but we're using legal transfer authority under the Omnibus Appropriation Act,” he said, adding he hoped to have access to the money this month. Bush also said he would seek an additional $125 million in the fiscal 2006 budget for “demonstration projects that will help test the effectiveness of health IT” and lead to its widespread adoption, according to a White House statement. Brailer said he views that sum and the $125 million to be requested for next year as a package that will be under the direction of his office. Various uses for the money include: funding new -- and expand existing -- regional health information organizations; establishing a mechanism to certify those organizations; promoting an ongoing program to certify electronic health records systems; and studying how to get physicians, particularly those in small group and solo practice, to adopt healthcare IT. Back to top More Physician Practices Adopt EMRs Preliminary results of an ongoing survey of members of the Medical Group Management Association released recently show that 69% of MGMA members are still using paper records. But that is changing, according to MGMA President and Chief Executive Officer William Jessee, M.D. Twenty percent of members surveyed reported having an electronic health record, defined as a system that is accessible through a computer terminal and stores medical and demographic information in a relational database. That's a big improvement from a couple of years ago when that number was around 9%, Jessee said. The survey showed 15% have a system that's fully implemented for all physicians at all practice locations; another 15% had a system that is either partially implemented, or fully implemented, but not at all locations. In addition, fully 40% of those surveyed indicated they would implement a system within the next two years. The survey is being conducted by the MGMA Center for Research with a grant from HHS' Agency for Healthcare Research and Quality. Back to top Many Physicians Doubt Error-Reduction Interventions Physicians’ ratings of the effectiveness of interventions to reduce medical errors are only weakly associated with published evidence of effectiveness, according to a new study in the February issue of Academic Medicine. The researchers asked a random sample of physicians to rate the effectiveness of 13 commonly prescribed error-reduction practices, including six for which evidence was cited from studies in peer-reviewed journals. On average, the physicians rated only 34% of the evidence-based practices and 29% of the practices without published evidence as “very effective” in reducing medical errors. Physicians affiliated with teaching hospitals were only slightly more likely to believe the practices would be effective. “More evidence, better dissemination strategies for existing evidence…and a focus on removing barriers to interventions may be needed to engage physicians in moving patient safety interventions into medical practice,” the study’s authors conclude. The study is at: http://www.academicmedicine.org/cgi/content/abstract/80/2/189 Back to top Tech Companies Agree On HIT Standards Eight of the nation's largest technology companies have agreed to embrace open, nonproprietary technology standards as the software building blocks for a national health information network. The agreement should help advance efforts to facilitate sending health data across the network and sharing information among doctors, hospitals, insurers and researchers. The eight companies said they formed an alliance, the Interoperability Consortium, to hasten the development of a digital health network. It submitted its recommendations to the government recently in a 134-page report. Companies in the consortium are I.B.M., Microsoft, Intel, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences. The group recommended that the government establish a nonprofit company called the National Health Technology Standards Corporation to be the arbiter of technology standards, with members of its board appointed by HHS. The consortium also said a national health network should not include a centralized database and that patients should control their own health records, deciding whether their information can be used in studies of the effectiveness of drugs and treatments. Back to top ACP Calls for HIT Incentives The American College of Physicians has called on Congress to create incentives for small-office physicians to adopt information technology, including electronic health records and clinical decision support tools at the point of care to guide physicians' treatment decisions. To create incentives, the group is promoting the National Health Information Incentive Act, which is expected to be introduced the week of February 7 by Reps. John McHugh (R-N.Y.) and Charles Gonzalez (D-Texas). The bill would authorize HHS to provide loans and grants to help small-practice physicians acquire new technology. It would also provide incentives to physicians who use technology to improve patient care, authorizing Medicare “add-on bonus payments” for office visits supported by electronic medical records and for e-mail consultations with patients. ACP is also proposing that Congress authorize a federal pilot program to test a new model for caring for patients with chronic diseases in small and medium-size practices. Under ACP's proposed model, patients with complex and multiple chronic diseases would select a physician as their “medical home,” a single point of care where patients could get treatment and trusted advice on navigating the complex health system. ACP is also asking that physicians have the choice of having their payments based in part on how well they attain quality care improvements. Back to top MedPAC Chief Says Medicare Should Reward Quality Gains Medicare providers should be rewarded financially for making progress toward delivering high quality care as well as for actually meeting quality standards imposed by the program, the head of the Medicare Payment Advisory Commission said Feb. 2. Glenn M. Hackbarth, the chairman of MedPAC, also told a meeting of AARP's board of directors that a pay-for-performance system should be budget-neutral and "not a backdoor way to achieve savings in Medicare." Rewarding Medicare providers for improving the quality of care they offer, rather than recognizing only those meeting or exceeding quality measures, would give providers an additional incentive to improve their care, Hackbarth said. Hackbarth suggested that a pay-for-performance program adopted by Medicare should contain two provisions: one rewarding providers for meeting quality standards, and one paying another group of providers for showing improvement on the measures. In January, MedPAC recommended that Medicare adopt pay-for-performance standards for hospitals, home health agencies, and physicians. The commission in 2004 called on the program to do so for managed care plans and dialysis facilities. The commission envisions that 1 percent to 2 percent of provider payments be put at risk to make payments for improving quality. Back to top Critical Care Nurses: Silence Kills The American Association of Critical-Care Nurses has a released a new study, Silence Kills, recommending “crucial conversations for health care.” The study reports that many hospital caregivers said they had seen a co-worker take dangerous shortcuts or exhibit poor clinical judgment, but did not speak up about their concerns. The association says ending that “culture of silence” would improve patient safety and outcomes, as well as workforce morale and retention, and recommended six steps hospitals can take to promote a more open and healthy work environment. Kathy McCauley, the group’s president, said, “Too often improving workplace communication is seen as a ‘soft’ issue’ -- the truth is we must build environments that support and demand greater candor among staff if we are to make a demonstrable impact on patient safety.” The study is available at: http://www.rxforbettercare.org/SilenceKills.pdf. Back to top JCAHO Launches “Speak Up” Campaign The Joint Commission on Accreditation of Healthcare Organizations has launched a campaign urging patients to take a series of steps to prevent medication mistakes at their doctor’s office, the hospital and in other health care settings. The “Speak Up” campaign includes a poster and brochure listing what patients can do to prevent medication mistakes, such as checking to be sure they can read the doctor’s handwriting on all prescriptions and when hospitalized, making sure their caregiver checks their wristband and verifies their name before administering medication. The campaign recommends that people avoid medication errors at the doctor's office by keeping a list of current prescription and over-the-counter medicines; reminding physicians about any allergies or reactions; and asking physicians whether it's safe to take medications together. It recommends that hospital patients ask the doctor or nurse why they should take a medication and request written information about the brand name, generic name and any side effects. It suggests patients speak up if they think the doctor or nurse is about to give the wrong medicine and tell the nurse or doctor if they don't feel well after receiving a medicine. The campaign also includes a wallet-sized card patients can use to keep track of all medications. JCAHO is sending copies of the poster, brochure and wallet card to all Fortune 1000 employers, and asking them to share the materials with their employees. The materials also can be downloaded free at: http://www.jcaho.org/news+room/press+kits/medication_mistakes/index1.htm Back to top New Briefing Book on Medicare/Medicaid The National Health Policy Forum has posted a new electronic briefing book, Understanding Medicare and Medicaid: Fundamentals and Issues for the New Congress, on its website at http://nhpf.ags.com/M&M_E.brief.book/Contents.htm. The briefings were requested by senior staff from the Senate Finance and House Ways and Means and Energy and Commerce Committees to provide an overview of the Medicare, Medicaid, and State Children’s Health Insurance programs. The sessions featured experts from the Government Accountability Office, Medicare Payment Advisory Commission, Congressional Research Service, and Centers for Medicare & Medicaid Services, in addition to other public and private entities. The book contains links to the sessions, presentations, and handouts as well as to additional reports, Web sites, and other resources. Coalition Proposes Apologies and Cash for Medical Errors A new coalition of patients, attorneys, doctors and hospital administrators across the nation wants to lower liability costs and help prevent medical errors at the same time. The group, called the Sorry Works! Coalition, proposes that: Hospitals and physicians review every adverse incident. Hospital administrators and physicians sit down with patients and families to explain what happened. The hospital and doctor apologize if a mistake was made, offer the patient or family fair compensation if the investigation finds that there was a medical error, and explain how the problem will be corrected. Organizers believe that the full disclosure and up-front settlements will have a big impact on the medical liability climate. Looking for a way to avoid escalating liability costs, several hospitals have for years offered apologies and up-front compensation to patients. The result, those involved say, has been better physician-patient relationships and lower legal costs. Patients are compensated faster for injuries, and physicians and patients avoid spending the time and money it takes to prepare to go to court. Johns Hopkins, Children's Hospitals and Clinics in Minneapolis and the University of Michigan Health System are among facilities that created disclosure policies in recent years that are similar to what Sorry Works! is advocating. The University of Michigan Health System saw legal costs drop to $1 million annually, down from the $3 million it used to spend. The coalition plans to be a centralized place people can come to for information on the model. It also plans to push state legislatures to create Sorry Works! pilot programs. Back to top Survey Shows Safer Medication Practices Spreading A new survey by the Institute for Safe Medication Practices show hospitals have made significant progress in crucial areas of medication safety over the past four years. The survey, conducted in partnership with the Health Research and Educational Trust and AHA through a grant from the Commonwealth Fund, allows hospitals to assess their use of nearly 200 practices that can improve medication safety. Areas of improvement since the first ISMP survey in 2000 include a 43% increase in the use of non-punitive, system-based approaches to error reduction; a 30% increase in implementation of standardized, automated methods of communicating drug orders, such as linking computer systems with pharmacies; 29% improvement in efforts to minimize problems with look-alike and sound-alike drugs; and 23% improvement in patient education. Preliminary survey results and comparative national data are now available at http://www.ismp.org/Survey/Hospital/Intro.htm. Back to top Physician Groups Seek To Cut Health Care Disparities The American Medical Association, National Medical Association and National Hispanic Medical Association have announced that they and two dozen additional physician and physician-related organizations have formed a commission dedicated to closing racial and ethnic disparities in health care. The Commission to End Health Care Disparities will work to raise physician awareness of health care disparities and develop strategies to eliminate gaps in care based on race and culture. Projects underway include a national survey of physicians about health disparities and the factors that cause them, and cultural competency training materials for physicians. The group expects to release the survey results in April, and a report evaluating the education and training materials in November. The commission was inspired by a 2002 Institute of Medicine report showing that racial and ethnic minorities experience a lower quality of health services and are less likely to receive routine medical care, regardless of income and insurance status. More information: http://www.ama-assn.org/ama/pub/category/14629.html NQF to Hold P4P Conference Registration and a draft agenda are now available for the National Quality Forum’s upcoming conference, "Pay for Performance: Guiding Principles and Design Conditions." The conference will be held March 1-2, 2005 at the Lansdowne Conference Center located in the greater Washington , DC area. The conference will look at the state of pay for performance and lessons learned from P4P projects. Participants will also seek to help establish guidelines and guiding principles for pay for performance efforts. Registration is open on a first-come, first-served basis to NQF Members and non-members. The deadline is February 24th. More info and registration at: http://www.qualityforum.org/txRegistration01-31-05FINALCLEAN.pdf. Back to top Ranks of Hospitalists Growing The number of hospitalists -- physicians who specialize in caring for inpatients -- has increased from just several hundred in the mid-1990s to more than 8,000 in 2003, according to a new report by the Center for Studying Health System Change. Researchers at the center said several factors, ranging from financial pressures and patient flow to safety concerns and rising malpractice costs, have contributed to the rapid increase in hospitalists, who typically care for patients whose own doctors lack admitting privileges or prefer not to provide inpatient care. The study, published in the February edition of the Journal of General Internal Medicine, examined trends in 12 nationally representative communities, and found that most major medical groups in some markets use hospitalists for a majority of their admitted patients. Better Teamwork for Safer Care Representatives from 27 health care organizations met in Washington , D.C. , recently to discuss devising ways to deal with safety problems arising from the increasing complexity of medicine. In a statement developed at the Patient Safety and Medical System Errors in Diabetes and Endocrinology Consensus Conference, participants called for improving teamwork, making better use of information technology and expanding professional and patient education to help patients live longer and better lives. "We needed to come together and examine the evidence and come up with recommendations for solutions to the problems we see," said Richard Hellman, MD, conference chair and University of Missouri/Kansas City School of Medicine clinical professor of medicine. Dr. Hellman said the conference looked at how systems have to take into account the fact that everyone makes mistakes. He explained how the consensus statement's call for backup checks includes a system that involves physicians, nurses, computers, pharmacists and even patient family members to make sure the sickest patients receive the care they need. Although patient safety often has a hospital-based focus, the Consortium also noted that primary care physicians have an important role to play in improving patient safety. Dr. Hellman said an important aspect was the coordination of care between primary care physicians and specialists. Back to top

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