Quality Update for August 4, 2005

President Bush Signs Patient Safety Bill into Law Representative Johnson Introduces Quality-based P4P Initiative CMS Releases ‘Quality Improvement Roadmap’ Series in The Washington Post Spotlights Medicare Issues CMS Announces Medicare Health Support Pilot Programs Surgical Care Infection Project Launched by Coalition Study Associates Availability of HIT with Delivery of Preventive Care JAMA: Hypertension Often Uncontrolled in Elderly President Bush Signs Patient Safety Bill into Law President Bush signed into law the Patient Safety and Quality Improvement Act of 2005, calling it a “ critical step toward our goal of ensuring top-quality, patient-driven health care for all Americans.” Among other things, t he bill creates a system for voluntary, confidential reporting of medical errors that shields information submitted by providers from civil, administrative, and criminal cases. The President characterized it as a “common-sense law” that protects health professionals who report their errors to Patient Safety Organizations. “ By providing critical information about medical procedures, doctors and nurses can help others learn from their experiences,” said Bush. AHQA worked for many years to ensure that QIOs would be eligible to be recognized as Patient Safety Organizations (PSOs) under the new law. “This is a great new opportunity for QIOs to engage with providers and practitioners to improve the quality of health care,” said Todd Ketch, AHQA Vice President of Government Affairs. “The national network of QIOs should be a primary source of PSOs under the new law.” As reported in the July 21 edition of AHQA Matters, the new law’s protections do not apply to information already collected separately from the patient safety process (like a patient’s medical record). Instead, it creates a new confidential “patient safety work product” that is to be used only for analysis and review to improve health outcomes. “When physicians can report errors in a voluntary and confidential manner, everyone benefits. Future errors can be avoided as we learn from past mistakes,” said American Medical Association president J. Edward Hill, MD in a statement. “This law strikes the proper balance between confidentiality and the need to ensure responsibility throughout the health care system.” The bill also requires facilitation of data exchange between patient safety organizations and development of voluntary national standards for electronic data exchange. AHQA will provide comments to the Agency for Healthcare Research and Quality during the regulatory process and carefully monitor the implementation of the patient safety law. The Association will also work with CMS officials to ensure that the agency’s “conflict of interest” requirements do not interfere with the ability of QIOs to operate as PSOs. Back to top Representative Johnson Introduces Quality-based P4P Initiative House Ways and Means Health Subcommittee Chairman Nancy L. Johnson (R-CT) introduced the Medicare Value-Based Purchasing for Physician’s Services Act of 2005, a bill that proposes to replace Medicare’s current physician payment system with pay-for-performance reimbursement. The legislation ties physician payment to their reporting of quality measures. The bill aims to use incentives for physician involvement and improvement in health care quality, to improve the quality of care provided to all beneficiaries. “Public reporting and payment incentives, coupled with technical assistance from the QIOs, are a powerful combination for improving quality,” said Todd Ketch , AHQA Vice President of Government Affairs. “All of these components are necessary for the dramatic improvements we want to achieve.” Beginning in 2007 and continuing in 2008, those doctors reporting quality measures will receive an annual increase equal to the Medicare Economic Index (MEI). Those not reporting the measures would get an update of one percentage point less. In 2009, physicians who either meet target levels for quality measures or show progress toward meeting them will receive a full MEI update, while those not meeting the measures or showing improvement would receive one percentage point less. Physician groups such as the American Medical Association (AMA), the American College of Physicians (ACP), and the American College of Surgeons are supportive of the bill. In a joint statement, ACP, the American Academy of Family Physicians, and the American Osteopathic Association lauded Chairman Johnson’s efforts to provide incentives to physicians for health care quality, “Our organizations recognize that quality improvement in the Medicare program is an important and worthy objective.” In a separate letter of support to Chairman Johnson, Mi chael Maves, MD, AMA Executive Vice President & CEO characterized the bill as “critical for ensuring continued quality of care and long-term access to health care services for Medicare beneficiaries.” The quality criteria at the heart of the bill have yet to be determined. BNA, a publication widely read by policy makers in Washington , DC , reports that “The quality standards [sic] will contain a mix of outcome, process, and structural measures; will include efficiency measures related to clinical care; be evidence-based; and include measures assessing the use of resources, according to a summary of the legislation distributed at the briefing.” BNA also reported that “doctors will be directly involved in creating the measures, which would be submitted to quality organizations such as the National Quality Forum, which would recommend measures to the Centers for Medicare & Medicaid Services.” Back to top CMS Releases ‘Quality Improvement Roadmap’ Mark McClellan, MD, Administrator, Centers for Medicare & Medicaid Services (CMS) has released the agency’s “Quality Improvement Roadmap,” a major, agency-wide effort that outlines how CMS plans to use the new Medicare law and other opportunities to work in partnership with the rest of the health care system to achieve major improvements and advancements in the quality of health care. The Roadmap lists five major strategies that CMS will pursue to achieve its mission of improving quality of care. Work through partnerships, including within CMS and HHS, with other Federal and State agencies, and with nongovernmental partners including health professionals. Publish quality measurements and information, including measures directed toward both the beneficiary audience and the professional/provider/purchaser audience. Pay in a way that supports providers and practitioners for doing the right thing – improving quality and avoiding unnecessary costs – rather than directing more resources to less effective care. Assist practitioners and providers in taking advantage of CMS quality initiatives and make care more effective and less costly, in particular greater use of effective electronic health systems. Become an active partner in driving the creation and use of information about the effectiveness of health care technologies, to bring effective innovations to patients more rapidly, and to help doctors and patients use covered treatments more effectively. Detailed discussion of the role of QIOs is presented under the 4 th strategy where the plan calls QIOs “CMS’ major vehicle” to help “safety net” and small providers and those in rural and underserved areas with quality improvement. AHQA’s EVP, David Schulke, asked OCSQ acting director Barry Straube, MD, whether this language signaled a coming diminution of the QIO technical assistance role, and was told unequivocally that there was no intention at CMS to convey that impression. CMS’ plan calls for QIOs to “help providers begin to make changes in four key areas: measuring and reporting on quality, redesigning care processes, transforming organizational culture, and adopting and effectively using health IT to support these objectives.” An AHQA statement in support of the “Quality Improvement Roadmap” was released on the same day and is available at: http://www.ahqa.org/pub/media/159_767_5239.cfm A PDF of the roadmap is available at: www.cms.hhs.gov/quality/quality%20roadmap.pdf Back to top Series in The Washington Post Spotlights Medicare Issues A series of articles by investigative reporter Gilbert Gaul appeared in The Washington Post in July. The three part series, “Chronic Condition: Medicare’s Oversight Gaps” addressed the Medicare payment systems, oversight and accreditation issues, and the QIO program. As the subheading “ High Quality Often Loses Out In the 40-Year-Old Program” suggests, part one discussed the Medicare payment structure that reimburses providers for care regardless of quality. Gaul writes that in Medicare’s “ upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine.” Part two, published on July 25 th, explained the role of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) with regard to its oversight responsibility in accrediting hospitals that receive Medicare payments. Gaul argued that recent changes to improve quality have created conflicts of interest for Medicare’s oversight components, specifically in JCAHO. “Medicare officials have stressed a more collegial approach in which the private groups and even some state regulators work together with the hospitals and other groups they oversee. The focus of this approach is collaboration, not punishment,” wrote Gaul. The “secrecy” of the QIO program was discussed in the final segment “ Once Health Regulators, Now Partners” on July 26 th. Gaul raised questions about the waning numbers of beneficiary complaints and the QIO process of handling them, the confidential nature of data used in quality efforts and complaints, and the lack of consumer involvement and meaningful oversight of the QIO program. Gaul did recognize that QIOs are essentially “ hamstrung by Medicare’s decades-old rules which place a premium on secrecy.” In an online Q&A session after the last series installment, Gaul answered questions from readers across the country. Several took issue with Gaul on his critical approach to the QIO program. His replies lacked the negative tone of the article. For example, in one response he said that QIOs are “ funded with tax dollars and play an important role” and that “They also happen to be interesting businesses and that’s worth reporting on as well.” Read the full series and transcript from Gaul ’s online Q&A at: http://www.washingtonpost.com/wp-dyn/content/discussion/2005/07/25/DI2005072501045.html Back to top CMS Announces Medicare Health Support Pilot Programs The Centers for Medicare & Medicaid Services (CMS) has announced the beginning of a new initiative, Medicare Health Support (formerly known as the Chronic Care Improvement Program or CCIP), designed to help beneficiaries with diabetes and congestive heart failure reduce their health risks and protect their quality of life.  Eight Medicare Health Support pilot programs will be offered this year as free, voluntary support programs, for approximately 160,000 fee-for-service Medicare beneficiaries for three years. Medicare Health Support programs will offer self-care guidance and support to chronically ill beneficiaries to help them manage their health, adhere to their physicians’ plans of care, and ensure that they know when to seek the medical care necessary. Specific strategies will include: access to nurse coaches to help people cope with their health concerns, tracking and reminding participants and their doctors about preventive care needs, use of health information technology to give physicians timely access to their patients’ information, home monitoring equipment to track participant health status, prescription drug counseling, and home visits and intensive case management. The programs will also include collaboration with participants’ providers to enhance communication of relevant clinical information to help increase adherence to evidence-based care, reduce unnecessary hospital stays and emergency room visits, and help participants avoid costly and debilitating complications. Each program will test a variety of interventions to bring about improvements in clinical quality, beneficiary and provider satisfaction, and reduced costs.  QIOs are involved in four states with MSH demonstration projects, at varying levels of engagement with the demonstration project contractors. In one surprising development, CMS officials have recently asserted to one of the QIOs that its proposed work with the MSH project – explicitly encouraged in every site in the CMS RFP for MSH – constituted a “conflict of interest.” AHQA is requesting a high level discussion with CMS officials to resolve this conflict in policy. Programs will begin between now and the fall at the following locations: Washington , DC and Maryland , Oklahoma , Western Pennsylvania , Mississippi , Northwest Georgia , Chicago , Tennessee , and Central Florida . CMS is also discussing the addition of a Brooklyn/Queens pilot. More information about the Medicare Health Support initiative is available at http://www.cms.hhs.gov/medicarereform/ccip. Back to top Surgical Care Infection Project Launched by Coalition A coalition of health groups asked hospitals across the country to join the Surgical Care Improvement Project (SCIP) at the American Hospital Association’s Health Forum in San Diego . SCIP is a national initiative to reduce four common surgical complications by 25 percent by 2010. Partners in SCIP include the Agency for Healthcare Research and Quality, the American College of Surgeons, the American Hospital Association, the American Society of Anesthesiologists, the Association of periOperative Registered Nurses, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Institute for Healthcare Improvement, the Joint Commission on Accreditation of Healthcare Organizations, and the Veterans Health Administration. Under the SOW8, QIOs will provide educational support and information on preventing surgical complications to all hospitals that participate in the SCIP project. QIOs will also offer all hospitals assistance on collecting data and publicly reporting their performance in implementing clinical processes proven to make surgery safer. For 20 percent of hospitals in each state, QIOs will offer intensive assistance. AHQA distributed a press release in conjunction with the SCIP announcement, which is available on the AHQA website: http://www.ahqa.org/pub/media/159_678_2434.CFM For more information: www.medqic.org/scip Back to top Study Associates Availability of HIT with Delivery of Preventive Care According to a Journal of the American Medical Association study, in some cases less than half of Medicare beneficiaries receive routine preventive services. Among other variables, physician practice setting and the “availability of information technology to generate preventive care reminders or access treatment guidelines” were associated with the delivery of preventive care. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6 percent of revenue from Medicaid were more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent), hemoglobin A1c monitoring (61.2 percent vs. 48.4), mammograms (52.1 percent vs. 38.9 percent), colon cancer screening (10.0 percent vs. 8.5 percent), and influenza (50.2 percent vs. 39.2 percent) and pneumococcal (8.2 percent vs. 6.4 percent) vaccinations. Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more and who was a graduate of a U.S. or Canadian medical school. The authors conclude, “Our results suggest that these variations in quality are substantial and seem to be greatly influenced by the structure and revenue sources of physician practices. If we can understand the mechanisms underlying these relationships, it would be much easier to identify the key leverage points for quality improvement.” Read the abstract at: http://jama.ama-assn.org/cgi/content/abstract/294/4/473 Back to top JAMA: Hypertension Often Uncontrolled in Elderly A study in the Journal of the American Medical Association indicates that high blood pressure among older women is not well controlled. The authors note that the prevalence of hypertension (high blood pressure) increases for both men and women with age. Nearly three quarters of individuals in the study over age 80 had hypertension but only about 38 percent of men and 23 percent of women received effective treatment. The researchers found that nearly 25 percent of those over 80 with serious hypertension had strokes, heart attacks, or other serious cardiovascular problems. The authors conclude that “greater efforts at safe, effective risk reduction among the oldest patients with hypertension” is needed. An abstract is available at: http://jama.ama-assn.org/cgi/content/abstract/294/4/466 Back to top

Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap