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MedPAC Calls For Pay-for-Performance CDC Issues Voluntary Guidelines for Public Reporting
of Hospital Infections Study: Medicare Can Reduce Disparities JAMA Questions Use of Health IT Systems 1000 Hospitals Join IHI Campaign NCQA Seeks Comment on Draft Standards for Quality
Plus ACS Launches Program to Ensure Quality of New
Surgical Procedures Many Medication Errors Made at Hospital Admission Study: Hospital Investment in IT Pays Off Diabetes Raises Risk of Liver Cancer CMS
Develops Provider Guide to Preventive Services In a report
to Congress on March 1, the Medicare Payment Advisory Commission concluded
that “it is time for the Medicare program to differentiate
among providers when making payments.” The Commission called for
Congress to instruct the Medicare program to design a pay-for-performance
system that rewards improvement, as well as attaining or exceeding certain
benchmarks. It said Medicare should pay more for higher quality care from hospitals,
home health agencies and physicians. The Commission has previously recommended
that Medicare adopt a pay-for-performance (P4P) policy for Medicare Advantage
plans and dialysis providers. The Commission
said that, “quality measures can be used to distinguish
among hospitals, home health agencies and physicians. In each of these
settings there is some consensus on a core set of measures. Where necessary,
adequate risk adjustment is available. Data needed to take these measurements
can be collected without undue burden on providers or the program.” The Commission
also said that the Centers for Medicare & Medicaid
Services should require reporting of lab values and prescription claims
data, which could be combined with physician claims to provide a better
picture of quality of care. Initially,
the Commission recommended, the Medicare P4P program should be funded
by setting aside a small percentage of budgeted Medicare payments—1
percent or 2 percent—to be earned by providers that deliver better
quality care. High performers and those with strong improvement rates would have
a chance of receiving more than the percentage that was taken away, while
others may not get any of those funds returned, Miller told reporters. The Commission
also called on CMS to designate quality measures that reflect the use
of IT systems, beginning in physicians’ offices.
It said CMS —through P4P and other means—should provide both
financial incentives and technical assistance to boost the adoption of
HIT. “By focusing on measures of quality-enhancing functions and outcomes
associated with IT use, the quality incentives in a pay-for-performance
program could spur physicians to adopt information technology that improves
care and helps the infrastructure for further assessment efforts,” the
report said. The Commission also suggested that CMS should measure resource use
of physicians serving Medicare beneficiaries and provide information
about practice patterns confidentially to physicians. The MedPAC
report is available at: http://www.medpac.gov/publications/congressional_reports/Mar05_TOC.pdf The Centers for Disease Control and Prevention (CDC) released guidelines
on February 28 designed to help states seeking to mandate public reporting
of hospital-acquired infections. However, the CDC advisory panel stopped
short of advocating or opposing mandatory reporting, saying there is
not enough evidence to show whether such reporting reduces infections.
Four states have enacted legislation requiring reporting; 30 more have
similar legislation on the table. “We don't know yet if public reporting will reduce the number
of infections, but we do support collecting information that can lead
to improvements in patient safety,” says Dr. Denise Cardo, director
of the CDC's division of health care quality promotion. The CDC guidelines recommend that hospitals track common hospital-based
infections by using established public health surveillance systems; consulting
with infection-control experts; measuring practices to prevent infections;
and providing regular and confidential feedback to health care providers.
Specifically, the CDC recommended establishing public reporting systems
for one or more of the following: central-line insertion practices, prophylactic
antibiotics for surgery, flu vaccination, bloodstream infections associated
with a central-line, and surgical site infections following specific
surgical procedures. More than 2 million hospital-associated infections occur each year resulting
in approximately 90,000 deaths and $4.5 billion in excess health care
costs. The guide is available at: http://www.cdc.gov/ncidod/hip/PublicReportingGuide.pdf Improving the quality of care for diabetic patients could save money
and lives according to a March 1 report from the Agency for Healthcare
Research and Quality. The AHRQ report says that multiple hospitalizations
are common among individuals with diabetes. It points out that complications associated with diabetes result in
significant costs to the health care system, particularly for public
insurance programs, and are largely preventable. The agency’s
Healthcare Cost and Utilization Project (HCUP) used hospital data from
2001 to analyze the health and costs of care for diabetes-related complications.
Key findings include: The report suggested that health care expenditures could be lowered
and the quality of care elevated by offering heart disease interventions
to diabetic patients, carefully monitoring diabetic patients who have
previously been hospitalized, and enhancing interventions for groups
most vulnerable to diabetes. One major
article in the edition, by J une Eichner and Bruce C. Vladeck looks
at “Medicare As A Catalyst For Reducing Health Disparities.” The
article reports on a National Academy of Social Insurance ( NASI) study
panel exploring how Medicare could use its leverage to reduce disparities,
for both its beneficiaries and the rest of the nation. The article
contends that Medicare has been “instrumental in reducing
disparities in health coverage between racial and ethnic minority groups
and whites.” However, it also points out that, “even among
Medicare beneficiaries, marked disparities persist in treatment and health
status, although they are smaller than the disparities that minority
beneficiaries experience before becoming entitled to Medicare.” Authors
of the article say that the NASI study panel is still at a relatively
early stage in its work but has already identified some preliminary
conclusions and areas for further exploration. Noting that by 2030
minorities are expected to account for 26 percent of the Medicare population
age sixty-five and older, the study concludes that “Medicare
should take the lead in reducing disparities.” For the full article: http://content.healthaffairs.org/cgi/content/abstract/24/2/365. Two studies
and an editorial in this week’s JAMA question the
push to adopt current health care IT systems and offer guidance for effectively
using HIT systems to improve quality of care. In “ Role of Computerized Physician Order Entry Systems
in Facilitating Medication Errors ,” by Ross
Koppel, PhD, and others, researchers found that a widely-used CPOE
system in a tertiary care teaching hospital facilitated 22 types of
medication error risks. The authors
conclude that “ As CPOE systems are implemented,
clinicians and hospitals must attend to errors that these systems cause
in addition to errors that they prevent.” In “Effects
of Computerized Clinical Decision Support Systems on Practitioner
Performance and Patient Outcomes, A Systematic
Review ”, authors Amit
X. Garg, MD, and others review controlled trials assessing the
effects of computerized clinical decision support systems (CDSSs).
The authors looked at systems for prevention, for disease management,
and for drug prescribing. Noting
that a primary consideration in adopting a CDSS is its clinical effectiveness,
the authors recommend that institutions need to “measure
effects on local outcomes and be prepared to iteratively modify their
system in response to practice-based knowledge.” In an editorial,
JAMA notes that, “Behind the cheers and high
hopes that dominate conference proceedings, vendor information, and large
parts of the scientific literature, the reality is that systems that
are in use in multiple locations, that have satisfied users, and that
effectively and efficiently contribute to the quality and safety of care
are few and far between. ” The editorial says that applying IT
to health care is a complex process that will require a great deal more
careful development than is currently taking place. The editorial
concludes that important lessons about introducing new technologies
into complex work seem to have been missed: “This
is true at both the organizational level and the national level; a national
health IT infrastructure without a clear logic about how health care
organizations will become engaged in this infrastructure is bound to
fail.” Dr. David
J. Brailer, the administration’s national coordinator
for health information technology, told the New York Times the JAMA articles
are a “useful wake-up call,” though he said the findings
were “not surprising.” In health care, as in other industries,
he said, technology alone is never a lasting solution. Brailer
took issue with the JAMA suggestion that the Bush administration is
encouraging a headlong rush to invest in health information technology,
the Times reported. Brailer said that for the next year his policy
efforts will be to try to encourage the health industry to agree on
common computer standards, product certification and other measures
that could become the foundation for digital patient records and health
computer systems—not
rush into investment and adoption. The Institute for Healthcare Improvement announced at
the end of February that more than 1000 hospitals in 50 states and the
District of Columbia have agreed to participate in its 100,000 Lives
campaign. IHI hopes to enlist up to 1000 more hospitals in the coming
months. Introduced on December 14, 2004 , the campaign aims to save 100,000
lives by June 14, 2006 (18 months) by instituting proven best practices
in hospitals. Already
on board are more 60 health care systems, including the Veterans Health
Administration, Ascension Health, Ardent health, and Baylor Health
Care System—as well as hundreds of individual
hospitals. More than a dozen Quality Improvement Organizations have joined
the campaign. AHQA is a national partner. Hospitals
joining the campaign have made a commitment to implement some or all
of the following 6 quality improvement changes: a rapid response team,
utilization of evidence-based care for acute myocardial infarction,
medication reconciliation to prevent adverse drug events, utilization
of a “central line bundle” to prevent infections, employment
of surgical infection control practices, and use of a “ventilator
bundle” to reduce mortality and length of stay in the Intensive
Care Unit. For more information, contact Danielle Rhoades at (212)
576-2700 x242 or Allison Aldrich at (212) 576-2700 x241. To learn more
about joining the campaign, go to http://www.ihi.org/IHI/Programs/Campaign/ On March 2, the National Committee for Quality Assurance issued for
comment its draft standards for Quality Plus, a multi-year voluntary
program launched in 2004 to identify health plans which adopt practices
that promote high quality health care. Comments on the standards are
due April 18. Quality
Plus is designed for health plans seeking to demonstrate that they
measure the quality of care delivered by their network doctors and
hospitals. The draft standards include innovative strategies for improving
health care quality while emphasizing wellness and disease prevention,
chronic illness management, complex case management, and physician and
hospital performance. Organizations that use Quality Plus are required
to utilize measurement outcomes to improve quality of care through such
mechanisms as public reporting or pay-for-performance programs. More information
is available at http://www.ncqa.org/Programs/Qualityplus/PublicComment.htm In February,
the American College of Surgeons voted to expand its current efforts to
ensure quality surgical care by including emerging technology and new surgical
procedures provided by all specialties. First on the list is bariatric
surgery. The
initiative will make sure surgeons are competent in new and innovative
surgical procedures and that surgical facilities are accredited to
provide care for those procedures. ACS Executive Director Thomas R.
Russell, MD, says the program will “ensure that the highest standards
governing surgical care are followed and that the end result for the
surgical patient will be the best possible outcome.” In the February 28 edition of Archives of Internal Medicine,
Canadian researchers report that potentially harmful medication errors
occur about 50 percent of the time during hospital admission. By reviewing
151 medical charts, investigators found 140 medication errors made
at the time of admission. The errors included drug omissions, incorrect
doses or frequencies, and use of the wrong drugs. M ore than 30% of
the medication errors could have caused moderate discomfort or clinical
decline; nearly 6% could have resulted in severe consequences.Timing
of hospital admission did not affect the number of reported errors. The
researchers conclude that “the processes for recording medication
histories on admission to the hospital are inadequate, potentially dangerous,
and in need of improvement.” A report released this week by Pricewaterhouse Coopers recommends increased
hospital investment in information technology, concluding that boosting
HIT can reduce patient stays, increase revenues, and improve health care
quality. The report, Reactive to Adaptive: Transforming Hospitals with Digital
Technology, says IT is not a panacea but could help hospitals
with pay-for-performance, clinical data reporting, improving patient
satisfaction, and more rapid adoption of new clinical practice guidelines. The report recommends those interested in pursuing IT start with a
strategic business plan and that physicians play a central role in development.
In addition, the report suggests that patients and payers be involved
in IT projects so they will begin to see immediate rewards of the system.
Hospitals should also recognize that successful implementation may depend
on forging a productive relationship with IT vendors. Read the full report at http://www.pwc.com/digitalhealth A large study published in the April edition of Gut indicates
that having diabetes significantly raises the risk of liver cancer. The study using Medicare data is the first population-based study in
the US that takes other major risk factors for liver cancer into consideration,
according to Dr. Hashem El-Serag, at Baylor College of Medicine in Houston,
and colleagues. After accounting for demographic factors, the likelihood of developing
liver cancer was three times higher for people with diabetes than for
those without. "Diabetes may account for a significant proportion" of
cases of liver cancer, El-Serag's group concludes. A guide
to help health care professionals understand new Medicare preventive
services is now available on the Centers for Medicare & Medicaid
Services website. The guide is designed to increase professional and public understanding
of preventive benefits added by the Medicare Modernization Act of 2003
such as the Welcome to Medicare Visit and Cardiovascular and Diabetes
Screening, as well as existing preventive services available under Medicare. “The
Guide to Preventive Services for Physicians, Providers, Suppliers,
and Other Health Care Professionals” includes:
detailed service explanations, coverage guidelines, frequency parameters,
coding and diagnosis information, billing requirements, reimbursement
information, reasons for claim denial, and Written Advance Beneficiary
Notice ( ABN ) requirements. For more information, go to: http://www.cms.hhs.gov/medlearn/psguid.pdf  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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