Quality Update For February 25, 2005

AHRQ Releases Second Annual Quality, Disparity Reports CMS To Broadcast Preview of Hospital Quality Site for Consumers NQF panel issues draft HCAHPS Recommendations GAO Report Indicates Services to Medicare Beneficiaries on the Rise AMA/MedPAC Differ on Physician Incentives AHA Calls for Public Reporting of Quality in All Hospitals by 2010 MDs Earn CMEs While Improving Quality of Care Efforts Increase to Raise Quality of Care for Stoke Victims RX Groups Request CMS Panel on Medication Therapy Management NQF Adopts National Guidelines for Home Health Care NQF Invites Comments on Standards for Diabetes Care and Patient Safety Taxonomy Survey: Hospitals Planning For EMRs e-Prescribing Initiatives Started in MD, MI AHRQ Releases Second Annual Quality, Disparity Reports The Agency for Healthcare Research and Quality (AHRQ) has released its second annual reports on quality and disparities in health care in America. The 2004 National Healthcare Quality Report shows areas of improving quality as well as noting specific areas in which major improvements are needed. The 2004National Healthcare Disparities Report documents major disparities related to race, ethnicity, and socioeconomic status in American health care. The reports measure quality and disparities in four key areas of health care: effectiveness, patient safety, timeliness and patient centeredness. The reports also present data on the quality of and differences in access to services for clinical conditions, including cancer, diabetes, end-stage renal disease, heart disease, and respiratory diseases; and for nursing home and home health care. The Quality Report stresses that the gap between the best possible care and actual care remains large and that quality of care remains highly variable across the country. It concludes that further improvement in health care is possible: best practices have been identified, and collaborative, focused efforts among key stakeholders have produced impressive and inspiring gains. The 2004 Quality Report notes that across the entire set of measures, quality has improved by approximately 3 percent versus data reported in the 2003 report. In addition, since the 2003 Quality Report, improvements have been made in specific measures related to health care delivery. The greatest changes were in the following: A decrease of 37 percent from 2002 to 2003 in the percentage of nursing home patients who have moderate or severe pain. A decrease of 34 percent from 1994 to 2001 in the hospital admission rate for uncontrolled diabetes. A decrease of 34 percent from 1996 to 2000 in the percentage of elderly patients who were given potentially inappropriate medications. The 2004National Healthcare Disparities Report presents data on the same clinical conditions and other measures as the Quality Report but focuses on priority populations, including women, children, the elderly, racial and ethnic minority groups, low-income groups, residents of rural areas, and individuals with special health care needs, specifically children with special needs, people in need of long-term care and people requiring end-of-life care. The 2004 Disparities Report stresses that disparities are pervasive; and that gaps in information exist, especially for specific conditions and populations. The report presents a subset of measures for 2000 and 2001, showing that in both years : Blacks received poorer quality of care than whites for about two-thirds of quality measures. Asians received poorer quality of care than whites for about 10 percent of quality measures. American Indians and Alaska Natives received poorer quality of care than whites for about a third of quality measures. Hispanics received lower quality of care than non-Hispanic whites for half of quality measures. Poor people received lower quality of care for about 60 percent of quality measures. The two reports are available on www.Qualitytool.ahrq.gov. Back to top CMS To Broadcast Preview of Hospital Quality Site for Consumers The forthcoming site, “Hospital Compare,” will be available for preview during a satellite and Internet broadcast March 10. During the broadcast, the Centers for Medicare & Medicaid Services and the other Hospital Quality Alliance partners will share details on plans for a national rollout of the site and offer a live question and answer session. CMS currently plans to make Hospital Compare live in late March. For more information: http://www.cms.hhs.gov/quality/hospital/HQIDescription.pdf. Back to top NQF panel issues draft HCAHPS Recommendations The National Quality Forum steering committee reviewing the latest draft of the patient perceptions of care survey known as HCAHPS issued its recommendations this week for public comment by March 18. The 22-member panel recommended a total of 27 survey questions, including five patient demographic questions and 22 questions on seven key aspects of hospital care. The committee also offered recommendations on survey sampling, administration, scoring and public reporting. Based on comments received, the NQF plans to submit a revised survey to NQF members for a vote in early April as part of its consensus process. The survey, developed by the Centers for Medicare & Medicaid Services and Agency for Healthcare Research and Quality, seeks to create a standardized tool to compare patients' experiences with hospital care. The full list of the NQF’s recommendations, along with background material is at: http://www.qualityforum.org/webhcahpsALL02-18-05.pdf. Back to top GAO Report Indicates Services to Medicare Beneficiaries on the Rise In January the Government Accountability Office released the report, “Medicare Fee-for-Service Beneficiary Access to Physician Services: Trends in Utilization of Services, 2000 to 2002.” The reports finds that Medicare payment decreases have not resulted in a reduction of services to Medicare Fee-for-Service (FFS) recipients, despite concerns raised by physicians groups that reduced fees would cause many doctors to limit services offered to beneficiaries. The report found that during the study period, 2000-2002, the percentage of Medicare FFS beneficiaries that received physician services increased, as did the number of services provided to FFS beneficiaries who visited a physician. On average, the number of office visits for both new and existing FFS patients also increased. The Centers for Medicare & Medicaid Services submitted comments on the report, agreeing with the GAO findings. The agency stated the results were “a very useful measure to assess overall access of Medicare beneficiaries to medical services.” The full report is available online at www.gao.gov. Back to top AMA/MedPAC Differ on Physician Incentives Representatives of the American Medical Association and the Medicare Payment Advisory Commission took opposing stances in testimony before a House panel on February 10 on how to provide financial incentives to physicians for improvements in quality of care. AMA representative Nancy H. Nielsen said physicians need to invest in technology and personnel to improve quality and she cautioned that it is unreasonable to expect physicians to take such financial risks while Medicare payments are being cut. She said that implementing financial incentives for improvements in quality of care before the Medicare physician payment system is changed could result in reduced payments to those physicians who could not afford to invest in quality improvement initiatives. Glenn M. Hackbarth, chairman of the Medicare Payment Advisory Commission contended that instituting quality improvement efforts and revising the physician payment formula are “equally important and urgent.” He suggested that both efforts be instituted simultaneously, urging movement towards a pay-for-performance model. Hackbarth recommended that physician payments be based on their ability to collect and use data that could improve quality of care and their use of clinical standards or evidence-based standards of care. Bruce Steinwald, director of health care-economic and payment issues at the Government Accountability Office discussed two options to revise the current reimbursement system --eliminate the use of spending targets or remove the in-office Part B drug expenditures. More information about the hearing is at http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=376. The GAO report is available at http://www.gao.gov/new.items/d05326t.pdf. Back to top AHA Calls for Public Reporting of Quality in All Hospitals by 2010 At a meeting early this month, the American Hospital Association announced six long-term critical goals designed to strengthen the nation's health care system by 2010. The goals call for public quality reporting by every hospital, national information technology standards to support “interoperability” among hospitals and healthcare settings, 300,000 more healthcare professionals in hospitals, the staff, equipment, and training to be self-sufficient for 48 hours following a mass casualty incident, access to care for 25 million more Americans and improvements in care of the chronically ill. AHA President Dick Davidson urged cooperation among private and public health leaders to attain these goals. Back to top MDs Earn CMEs While Improving Quality of Care The American Academy of Family Physicians recently launched a new online continuing medical education program, Measuring, Evaluating and Translating Research Into Care (METRIC), designed to help physicians improve the quality of patient care while helping them meet CME requirements. The METRIC program consists of a series of quality improvement modules, focusing on single disease conditions. The first two modules are being released in 2005. Each module includes a practice assessment survey and chart audits of patient records on evidence-based performance measures. Physicians then receive online a baseline report of their performance measurement data, and develop an action plan with interventions. A second chart audit is completed six months later and improvements in performance data are noted. After completion of the course, the family physician certifying board is notified and CME credit is awarded. The online program aims to improve quality of care in the office while teaching doctors about a specific disease, says Bruce Bagley, MD, medical director of quality improvement for the AAFP. Back to top Efforts Increase to Raise Quality of Care for Stoke Victims TPA is remarkably effective at limiting damage if stroke victims get the drug soon enough. But studies presented at an American Stroke Association conference this month show that few stroke victims get TPA even if they do seek help in time. The new studies show that operators answering phones at hospitals often don't recognize stroke symptoms and discourage callers from coming in for help; that ambulances routinely take people to the nearest hospital instead of one with the necessary equipment and expertise to give TPA; that emergency room doctors are afraid of the drug's potentially serious side effects, and are unwilling to use it even when test results clearly show they should; and that even specialized stroke centers designed to speed the drug to patients are missing many chances to get it right. Action by the Joint Commission for Accreditation of Healthcare Organizations may help. A year ago JCAHO started accrediting stroke centers that meet standards for care aimed at improving treatment of stroke. As a result, 88 hospitals in 28 states are now accredited. In addition, some states such as Florida, New York, Maryland, and Massachusetts have developed their own stroke center standards. The American Stroke Association is also conducting a “Get With The Guidelines” campaign to promote better stroke care. More information on improving stroke care: http://www.strokeassociation.org/presenter.jhtml?identifier=3028574 Back to top RX Groups Request CMS Panel on Medication Therapy Management A coalition of pharmacist organizations has asked the Centers for Medicare & Medicaid Services to create a panel of government and private industry experts to advise the agency on basic provisions that Medicare Part D providers should include in medication therapy management programs. The Pharmacist Provider Coalition (PPC) urged CMS Administrator Mark McClellan to establish an advisory panel of pharmacists and other experts who have implemented successful medication therapy management programs (MTMPs) in private and state Medicaid settings. Section 423.153(a) of the final rule implementing the Part D prescription drug benefit, issued Jan. 21 by CMS, requires drug plan sponsors to establish MTMPs to “optimize therapeutic outcomes through pharmacists working with targeted beneficiaries” to improve medication use and reduce adverse drug events. The drug benefit final rule was published in the Jan. 28 Federal Register (70 Fed. Reg. 4193). In the final Part D rule, CMS said that plan-sponsored MTMPs may include features targeted toward beneficiaries such as promoting appropriate use of medications, helping patients adhere to drug regimens, and detecting adverse events and track under- and over-use. CMS said it believed MTMPs should provide adequate services for targeted beneficiaries, but that it did not want to mandate regulatory requirements that could negatively impact the development and improvement of MTMPs. Nevertheless, the final rule stated that MTMPs “must evolve and become a cornerstone” of the Part D benefit. The seven PPC members are the Academy of Managed Care Pharmacy, the American Association of Colleges of Pharmacy, the American College of Clinical Pharmacy, the American Pharmacists Association, the American Society of Consultant Pharmacists, the American Society of Health-System Pharmacists, and the College of Psychiatric and Neurologic Pharmacists. Information about the Pharmacist Provider Coalition is available at http://www.improvingmedicationuse.com/imu.cfm. Back to top NQF Adopts National Guidelines for Home Health Care The National Quality Forum has adopted national voluntary consensus standards for home health providers intended to improve the quality of home health care, assist consumers in making decisions, and aid physicians and discharge planners in placement decisions. The approved standards include 15 performance measures, eight research documentations, and nine additional recommendations. For more information on the Home Health Performance Measures, visit www.QualityForum.org. NQF Invites Comments on Standards for Diabetes Care and Patient Safety Taxonomy On February 10, The National Quality Forum made two draft consensus reports available for review and comment by NQF members and the public. The reports, “National Voluntary Consensus Standards for Adult Diabetes Care: 2005 Update” and “Standardizing a Patient Safety Taxonomy,” can be accessed on the NQF website, www.qualityforum.org. The diabetes draft is an update of the 2002 “National Voluntary Consensus Standards for Adult Diabetes Care,” which listed 37 measures endorsed for quality improvement and accountability developed by the National Diabetes Quality Improvement Alliance. The new draft includes 54 measures for public reporting and quality improvement at the health plan and provider level as well as three community-level measures developed by the Agency for Healthcare Research and Quality. The “Standardizing Patient Safety Taxonomy” draft report represents the nation’s first effort to organize, classify, and code patient safety information in a standardized fashion. Public comments on both documents are due by close of business, March 4, 2005 ; NQF member comments may be submitted until close of business March 11, 2005. Recommended for endorsement is the Patient Safety Even Taxonomy, developed by the Joint Commission on Accreditation of Healthcare Organizations. More information at www.qualityforum.org. Back to top Survey: Hospitals Planning For EMRs Results of the annual Health Information and Management Systems Society survey, released February 15, indicate that nearly two-thirds of hospitals expect to implement an electronic medical record system within two years. Nearly one in five of the hospital information technology executives surveyed said their organization has already implemented an EMR. Budgets and financial concerns remain the primary barrier to IT implementation, along with vendor inability to deliver appropriate product or service, lack of staffing resources, difficulty proving return on investment, and lack of clinical support. In the survey, reduction of medical errors was noted as the top business issue facing Chief Information Officers this year followed by patient satisfaction, improving quality of care, improving operational efficiency, and cost pressures. The survey, conducted in December 2004 and January 2005, queried executives who oversee technology operations at 550 hospitals and health organizations across the US. Back to top e-Prescribing Initiatives Started in MD, MI Twenty-seven health care organizations in Maryland have set up a consortium to increase physician adoption of electronic prescribing to improve patient safety. The Maryland Safety Through Electronic Prescribing initiative, the first such program in the nation, will provide a collaborative forum for stakeholders to discuss the challenges to e-prescribing adoption. Members of the Maryland STEP initiative (including the Maryland State Medical Society and Maryland Health Care Commission) plan to reduce medical errors related to misinterpreted written and verbal instructions, unclear abbreviations or dose instructions, and problems with faxed documents. In Michigan, Detroit automakers are teaming with Michigan ’s largest health care insurers, Henry Ford Health System, Blue Cross Blue Shield of Michigan, and Health Alliance Plan, to implement an electronic prescription system. Facing rising healthcare expenses, the ePrescribing system’s goal is to decrease healthcare costs and improve quality. About 25 doctors at the Henry Ford Health System are already using the new system; 17,000 more are expected to join the initiative over time. Also participating are Medco Health Solutions Inc., which manages drug benefits, and RxHub LLC, a computer company that will transfer pharmacy information between medical offices, the pharmacy benefit manager and the pharmacy. Back to top

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