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Four Top
Senators Combine HIT Bills to Spur Movement NEJM
Studies Analyze Hospital Performance First Ever
Statewide Report on Nosocomial Infections CMS Plans
for Medicaid P4P Program New Online
Resource Helps Low-Income Seniors Save Money Study Reveals
Gaps, Variations in Quality of Heart Care NCQA Adds
to Online Tool that Evaluates Health Plans Berwick
Knighted by Queen Elizabeth II Senate Majority Leader Bill Frist (R-TN) and Senator Hillary Clinton
(D-NY) have merged their bill to promote the spread of health information
technology with a similar measure proposed by Senate Health, Education,
Labor and Pensions (HELP) Committee chairman Mike Enzi (R-WY) and Senator
Edward Kennedy (D-MA). The new legislation, now known as the Wired for
Health Care Quality Act ( S. 1418) was approved the HELP Committee on
July 20. The combined
legislation promotes public-private sector initiatives to develop electronic
medical records and computerized prescribing that can make the U.S.
health system more efficient while reducing errors. One overarching
goal is to develop a foundation for “interoperability” that
will allow different health information systems to easily communicate
with each other. “I
am hopeful that this strong and broad show of bipartisan support will
help speed us toward enactment of our legislation this session,” said
Senator Clinton in a statement. Senator Frist is also urging the full
Senate to “move quickly” on this measure. NEJM Studies Analyze Hospital Performance Two studies published in the New England Journal of Medicine (NEJM)
examine standardized hospital quality data to assess hospital quality
in communities across the nation. Both studied care for heart attacks,
heart failure, and pneumonia. One found widespread variations in care;
the other showed significant improvements in care in hospitals overall. In one study, Harvard researchers used individual hospital data from
Hospital Compare (www.hospitalcompare.hhs.gov)
to evaluate the quality of hospital care in communities across the nation.
They found wide variations among regions and even within individual hospitals
on difference quality measures related to heart attacks, congestive heart
failure, and pneumonia. Using data from 3,558 hospitals, the researchers studied 10 quality
indicators. They found that for 6 of the 10 indicators, hospitals failed
to give patients needed care about 10 to 20 percent of the time. For
the other 4 indicators, performance was much worse. They also found that hospitals that provided high quality care for
heart attack also did well in providing good care for congestive heart
failure. However, high quality care for patients with heart attacks did
not necessarily mean high quality care for patients with pneumonia. Other findings: In its
July 21 article about the study, The Wall Street Journal said, “ Today’s
findings help confirm what a number of studies have suggested in recent
years: that geography matters when it comes to quality of health care.” Another study in the NEJM from the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) shows that American hospitals have,
on average, significantly improved care for patients suffering from heart
attacks, heart failure, and pneumonia over the past two years of public
reporting. Researchers used 18 evidence-based, standardized measures to track
hospital performance such as giving aspirin to patients with acute myocardial
infarction (heart attack) both within 24 hours of admission and at discharge
and providing smoking cessation counseling for heart failure and pneumonia
patients. Data were collected from more than 3,000 general acute care hospitals
and improvement ranged from 3 to 33%. An abstract
of the Harvard study, “ Care in U.S. Hospitals — The
Hospital Quality Alliance Program” is available at: http://content.nejm.org/cgi/content/short/353/3/265 The
JACHO study, “Quality of Care in U.S. Hospitals as Reflected by
Standardized Measures, 2002–2004” is available at: http://content.nejm.org/cgi/content/short/353/3/255 The report “Hospital-acquired Infections in Pennsylvania,” a
first-ever accounting of statewide data, taken from 1.5 million discharges
from 173 general acute care hospitals in 2004, shows that hospitals reported
11,668 confirmed hospital-acquired infections. These were associated
with 1,793 deaths, an estimated 205,000 extra hospital days, and $2 billion
in additional hospital charges. Last year, Pennsylvania became the first state to begin collecting and
reporting information on hospital-based infections. F ive states, including
Illinois and Missouri , have adopted laws to require regular reports
of hospital infections and many others have similar measures pending,
according to an article on the findings published by The Wall Street
Journal on July 13. Pennsylvania hospitals were required to submit data on four types of
hospital-acquired infections: three surgical site infection categories,
and Foley catheter-associated urinary tract infections, ventilator-associated
pneumonia, and central line-associated bloodstream infections. Beginning
January 1, 2006, hospitals will be required to submit data on all hospital-acquired
infections. The data is submitted to Pennsylvania Health Care Cost Containment
Council (PHC4), author of the report. PHC4 is an independent state agency
charged with collecting, analyzing and reporting information that can
be used to make more informed decisions to improve the quality and restrain
the cost of health care in the state. Although
the agency expressed satisfaction that many hospitals provided data
in 2004, it says compliance and reporting discrepancies remain a concern.
For example, there is a large discrepancy between the number of hospital-acquired
infections reported by hospitals (11,668) and the 115,631 infections
billed to purchasers, private insurers, and government programs like
Medicare and the state’s Medical Assistance program.
Some large hospitals submitted invalid data while 16 hospitals, including
several large ones, reported no infections at all. As these issues are
resolved, the agency expects the number of reported infections to increase. PHC4 payment data shows that in 2003, the average payment for the treatment
of a patient with an infection was more than $29,000, compared to an
average payment of $8,300 for a patient without an infection. Much of
the extra cost is for additional days in the hospital. According to the
report, the average additional length of stay for patients who contracted
either a bloodstream infection or pneumonia was about 26 days. Patients
with urinary tract infections (the most commonly reported infection)
spent an average of 12.4 additional days in the hospital, while those
with surgical site infections spent an average of 7.8 additional days. Many Pennsylvania
hospitals actively participate in IHI’s 100,000
Lives Campaign and the surgical infection prevention project with Quality
Insights of Pennsylvania, the state’s QIO. Nevertheless, Marc P.
Volavka, Executive Director of PHC4 says, “Quality improvement
efforts must be redoubled, and hospital Boards and CEOs, along with those
paying the bills, must insure that infection control departments and
their dedicated staff get the support and resources they need to reduce
infections to the most minimally acceptable level. The quality case is
imperative, the business case is compelling.” The Centers
for Medicare & Medicaid Services (CMS) will soon launch
a Medicaid pay-for-performance (P4P) initiative. Terris King, Deputy
Director of the Office of Clinical Standards and Quality, discussed the
issue at a July 15 congressional briefing on P4P organized by the Alliance
for Health Reform. King said
CMS expects to produce a “detailed plan” for
Medicaid P4P in the coming months, according to BNA, a publication widely
read by Washington policy makers. King explained that “ a half
dozen” states have already developed P4P programs for Medicaid
providers and that the agency plans to use these programs as “benchmarks” for
other states to develop their own programs. King noted three key states
that will serve as models: California , Nebraska , and Vermont . King said that CMS will move into P4P first by paying providers for
reporting quality information, then reimbursing them for improving the
quality of care they offer. The programs will first rely on claims data,
then use clinical data, he added. CMS has already launched P4P programs for Medicare and Congress is
working on legislation to support this initiative. To view
a webcast of the event and King’s presentation, visit: http://www.allhealth.org/event_071505.asp The Centers
for Medicare & Medicaid Services has unveiled a new
online resource to help seniors take advantage of savings opportunities.
The resource was developed by the Administration on Aging (AoA) with
assistance from CMS and the National Council on the Aging (NCOA). The new service is a special version of BenefitsCheckUpRx (www.benefitscheckup.org/rx),
updated to provide extra help with Medicare drug coverage. It will help
older adults and their advocates take advantage of the additional Medicare
prescription drug benefit for low-income seniors, by screening beneficiaries
for eligibility and then providing a quick link to apply online through
the Social Security Administration’s Web site. The site
will also help seniors and their advocates apply for other needs-based
government programs including the Medicare Savings. The screening tool
incorporates state-specific income and asset eligibility requirements.
Information on differences among states' eligibility criteria is available
on the CMS website: www.cms.hhs.gov/medicarereform/states/whatsnew.asp Next year, Medicare beneficiaries who receive full Medicaid benefits
or who are enrolled in a Medicare Savings Program (MSP) will automatically
receive the extra help with their prescription drug costs. In an Archives of Internal Medicine study published in July,
authors found large gaps and variations in 223 hospitals for four standard
measures for heart failure treatment used by the Joint Commission of
Accreditation of Healthcare Organizations. The study points to the need
for hospitals to establish education programs and systems to improve
quality of care for heart failure patients. The measures and significant findings include: 1) Supplying the patient or caregiver with written instructions and
guidance on post-discharge care: Researchers found that only 24 percent
of patients hospitalized received complete discharge instructions. 2) Adequate assessment of left heart ventricular function: Researchers
found 86.2 percent of patients hospitalized had their heart function
assessed. 3) Prescription of an angiotensin-converting enzyme (ACE) inhibitor
drug upon discharge in appropriate patients: Investigators found that
only 72 percent of eligible patients were prescribed this therapy. 4) Counseling on smoking cessation for appropriate patients: Researchers
found only 43.2 percent of patients who were current or recent smokers
were counseled regarding smoking cessation. The difference in mortality rates between hospitals was fourfold, with
variations ranging from 1.4 percent of patients dying at the best-performing
hospitals to as high as 6.1 percent of patients at the worst- performing
institutions, according to the researchers. The authors also noted wide gaps in performance on certain measures.
For instance, in the poorest performing hospitals, less than one percent
of patients received discharge information; in the best performing hospitals
for this measure, 70 percent of patients were given the information. An abstract
of the study is available at : http://archinte.ama-assn.org/cgi/content/abstract/165/13/1469. The National Committee for Quality Assurance (NCQA) announced the addition
of a report that evaluates health plan activities that help people manage
chronic illness to its existing online Health Plan Report Card (HPRC)
on Monday. The new report, called Living with Illness, shows how effectively
health plans treat patients suffering from diabetes, heart disease, asthma,
and mental illness. Each report
shows the plan’s rates on up to 13 HEDIS measures;
HEDIS data are collected as part of every NCQA Accreditation survey.
To provide context for the results, the 90th percentile rates (or the
rate for the top 10% of all plans nationally) is also provided. HPRC
is available at http://hprc.ncqa.org/ In September, NCQA will add summary data to the Living with Illness
reports. These summary results will provide an indication of how well
a health plan performed on all the measures aggregated for each of the
four conditions. For more
information, contact NCQA at: www.ncqa.org. Donald M.
Berwick, MD, MPP, President and CEO of the Institute for Healthcare
Improvement (IHI) was appointed an honorary KBE (Knight Commander,
Order of the British Empire) by HM Queen Elizabeth II in recognition
of his “distinguished
service to healthcare improvement in Britain’s National Health
Service.” Berwick will formally receive the honor in a ceremony
later this year. Berwick and his colleagues at IHI have worked closely with the National
Health Service (NHS)
since the mid-1990s on projects such as a Modernization Plan for the
UK’s health care system and the planning and program setup
of the new National Patient Safety Agency. In addition to helping the
country’s health care leaders incorporate and adapt the quality
improvement methods of IHI and other US institutions, Berwick has endeavored
to provide an “outsider” and objective viewpoint for his
colleagues in the UK.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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