Quality Update for October 13, 2005

CMS: Critical Error in ‘Medicare & You’ Handbook RWJF Announces National Effort to Reduce Disparities; QIO Role Considered Nursing Homes Required to Immunize Residents Government Eases Barriers to ePrescribing and EHRs Commonwealth Releases New Chartbook at Hill Briefing New AHRQ Program to Identify, Spread Effective Care Case Review Linked with QI Leads to Substantial Improvement Leavitt Sets Agenda for American Health Information Community HHS Awards $17.5 Million to Improve EHRs JAMA Study Looks at P4P Impact on Quality AHRQ Awards Health IT Implementation Grants HHS Grants to Help Underserved in Katrina-hit Areas CMS to Fight Fraud in Rx Benefit QIOs Awarded Contracts to Help Fight Fraud Proposed Legislation Would Create New Office of Patient Safety and Health Care Quality at HHS Survey: Slow Implementation of HIT in Hospitals NCQA Report Ranks Health Plans Studies Indicate Preventive Measures Working for Heart Care CMS: Critical Error in ‘Medicare & You’ Handbook The Centers for Medicare & Medicaid Services (CMS) announced that an error was published in the new “Medicare & You 2006” handbook recently mailed to Medicare households. The error may cause some beneficiaries who qualify for “Extra Help” to believe they will pay no monthly premium for coverage with certain plans when, in fact, they would need to pay the difference between a regional benchmark and their chosen plan’s premium. In an email, CMS stated the nature of the error: “In the series of charts listing the specific Medicare Prescription Drug Plans, the last column of the charts is entitled ‘If I qualify for Extra Help, will my Full Premium be Covered?’  For each plan listed, this column should show ‘Yes’ if the plan’s premium is at or below the regional benchmark, and a beneficiary who qualifies for the low-income subsidy would pay no premium for this plan.  The column should show ‘No’ if the plan’s premium is above the regional benchmark and a beneficiary who qualifies for the low-income subsidy would pay the difference between the regional benchmark and the plan’s premium.  Due to an error, this column lists ‘Yes’ for every plan.”  The error occurs for approximately 60 percent of the PDPs listed in the handbook. It does not impact MA plans and will have no effect on auto enrollment. The agency is using multiple resources to make beneficiaries aware of this error. Beneficiaries can obtain accurate information regarding premium amounts by: Accessing the corrected Medicare & You Handbook online www.medicare.gov; Using the Medicare Prescription Drug Plan finder, which will be available soon on www.medicare.gov; Calling the organization offering the prescription drug plan; Calling 1-800-Medicare; or Utilizing personalized counseling in the community. Back to top RWJF Announces National Effort to Reduce Disparities; QIO Role Considered The Robert Wood Johnson Foundation (RWJF) has announced three new national initiatives aimed at developing and testing potential solutions to well-documented racial and ethnic disparities in health care delivery. The three programs, Expecting Success; Finding Answers: Disparities Research for Change; and Leading Change: Disparities Solutions Initiative, which represent a $23 million commitment from RWJF, “are designed to work in concert to identify tested, effective approaches that can become common practice in hospitals and communities nationwide,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the foundation. “It is time to move beyond documenting the unacceptable existence of these gaps in care and shift our focus to developing and testing solutions.” Expecting Success Ten hospitals participating in Expect Success: Del Sol Medical Center, El Paso , TX Delta Regional Medical Center, Greenville , MS Duke University Hospital, Durham , NC Memorial Healthcare System, Hollywood , FL Montefiore Medical Center, Bronx , NY Mount Sinai Hospital Medical Center, Chicago , IL Sinai-Grace Hospital, Detroit , MI University Health System, San Antonio , TX University of Mississippi Medical Center, Jackson , MS Washington Hospital Center, Washington , DC Administered by The George Washington University’s School of Public Health and Health Services, Expecting Success (http://www.expectingsuccess.org/about.html) is a national initiative to reduce ethnic and racial disparities in cardiac care. Directed by Bruce Siegel, MD, MPH, research professor, Department of Health Policy, the program will lead 10 hospitals through a collaborative effort to systematically measure and enhance the quality of cardiac care provided to their patients. The program will focus on improving cardiovascular care for African-American and Latino patients in both inpatient and outpatient settings. The George Washington University staff leading “Expecting Success” visited AHQA to brief staff on their project prior to the release. Project organizers expressed an interest in finding a way to work with QIOs from states with participating hospitals (see box). Dave Adler, AHQA Director of Government Affairs, noted that the project has great potential to improve data collection and measurement of care delivered to racial and ethnic minorities in hospitals and contribute effective interventions for reducing disparities and improving quality for hospital patients. Project leaders told AHQA staff that they are planning to release lessons learned from the project as soon as possible, including interim reports as early as Spring 2006. Finding Answers: Disparities Research for Change Led by Marshall H. Chin, MD, MPH, associate professor of medicine at the University of Chicago , Finding Answers: Disparities Research for Change will award and manage research grants totaling $5 million to organizations implementing and evaluating interventions aimed at reducing disparities. With this pool of funds, project leaders hope that health plans, hospitals, and community clinics will be encouraged to focus on racial and ethnic disparities as a priority in their quality improvement agendas. Leading Change: Disparities Solutions Initiative The Leading Change: Disparities Solutions Initiative will be directed by Joseph R. Betancourt, MD, MPH, assistant professor of medicine at Harvard Medical School and senior scientist at the Institute for Health Policy at Massachusetts General Hospital . The initiative will have two key functions—to synthesize and disseminate the results of other disparities projects funded by the Robert Wood Johnson Foundation (especially from the Finding Answers initiative) and then to inform health care systems working to develop and implement successful disparities interventions. Back to top Nursing Homes Required to Immunize Residents Nursing homes serving Medicare and Medicaid beneficiaries will have to provide immunizations against influenza and pneumococcal disease to all residents as a condition of participation in the programs, the Centers for Medicare & Medicaid Services (CMS) has announced. The final rule, published in the October 7 Federal Register, is available at: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-19987.htm. The rule requires nursing homes to educate residents and their families on the advantages and disadvantages of receiving the shots. Nursing homes are exempt if a resident cannot receive the shot for medical reasons or if they or their family refuse. About two million Americans, most age 65 years or older, live in long-term care facilities.  People aged 65 years and older account for more than 90 percent of influenza-related deaths, and elderly nursing home residents are particularly vulnerable to influenza-related complications. In addition, the elderly are more likely than younger individuals to die from pneumonia. “Improving immunization is a key element of our quality improvement strategy,” said Mark B. McClellan, MD, PhD, administrator of CMS.  In the final rule, CMS briefly mentioned QIO efforts to improve quality under Medicare through outpatient immunization efforts, but did not refer to any increase in the 8 th SOW to support the nursing home immunization initiative. Dave Adler, AHQA Director of Government Affairs, stated, “We will continue working with CMS to ensure that they recognize the important role QIOs can play by improving systems of care that help nursing homes reliably deliver vaccinations.” CMS is also encouraging nursing homes to provide influenza vaccine to their health care workers.  Back to top Government Eases Barriers to ePrescribing and EHRs The Department of Health and Human Services (HHS) has announced two new proposed regulations to support and speed adoption of e-prescribing and electronic health records by hospitals, physicians, and other health care providers. The Centers for Medicare & Medicaid Services (CMS) proposed exceptions to the “physician self-referral” law. The Office of the Inspector General (OIG) proposed safe harbors for arrangements involving the donation of technology for e-prescribing and electronic health records. Both proposals would allow hospitals and certain health care organizations to furnish hardware, software, and related training services to physicians for e-prescribing and electronic health records, particularly when the support involves systems that are interoperable. The CMS proposal would establish the conditions under which hospitals and certain other entities can give physicians hardware, software, or information technology, and training services for e-prescribing; the OIG proposal would establish conditions under which such entities may donate to physicians electronic health records software and related training services. The proposed rules are available in the October 5th Federal Register. Public comments will be accepted for 60 days. CMS plans to hold an Open Door Forum early in the public comment phase to discuss the benefits and risks of donating e-prescribing and electronic health records technology. Commonwealth Releases New Chartbook at Hill Briefing At a packed Capitol Hill briefing, The Commonwealth Fund Commission on a High Performance Health System, released its latest chartbook, A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency. Panelists at the briefing included: Stephen C. Schoenbaum, MD, executive vice president at The Commonwealth Fund; James J. Mongan, MD, president and CEO of Partners HealthCare; Gary Yates, MD, chief medical officer of Sentara Health; Dora Hughes, MD, health policy advisor to Senator Barack Obama (D-IL); and Madeleine Smith of the House Ways and Means Subcommittee on Health majority staff. The chartbook focuses on all aspects of health care system performance, painting a stark picture of a fragmented system with widespread differences in access to health care and the quality of care received by patients. The report also points to promising opportunities for system transformation, such as high-cost care management, enhancements in care coordination, disease management, and developing networks of high performing providers under Medicare, Medicaid and private insurance. Specifically, the report cites Medicare as an important mechanism for change. “Medication errors, medical mistakes, and variations in care compromise the quality of health care a person receives. We need standardized practices, tailored to individual patient characteristics and conditions, to improve care for everyone,” said Schoenbaum. Highlights from the report include: Need for Quality Enhancements Almost half of U.S. adults do not receive the level of care recommended for a particular condition. Nearly half the patients in one study did not receive reminders for preventive care. In a survey of U.S. adults, over 50% of individuals did not feel as though their doctor always spent adequate time with them. Only about one-fourth (27%) of physicians currently have electronic medical records. Need for Greater Efficiency The U.S. spends 14.6 percent of gross domestic product (GDP) on health care, compared to 9.6 percent in Canada and 7.7 percent in the United Kingdom. Nearly one-third (31%) of Americans who had seen a doctor in the past two years report poorly coordinated care. Standardization of practices can also create more effective care while decreasing costs. Administrative costs are the fastest rising component of health expenditures. Higher Medicare spending per beneficiary does not necessarily correlate with higher-quality care. Better information on quality and total costs of care could improve both quality and efficiency. Need for Better Access and Coverage Between 1987 and 2003, the working middle class saw the greatest increase in uninsured individuals. In 2004, 45.8 million individuals were uninsured, and that number is projected to exceed 50 million by the end of the decade; 26% of adults 19 to 64 were either uninsured all year or part of the year, while another 9% of adults, or 16 million people, were underinsured. Of uninsured adults, 61% reported having problems filling prescriptions, seeing a specialist, receiving a treatment or medical test, or even seeking advice on a medical problem. The Commission on a High Performance Health System, formed in June 2005, is charged with moving the country toward a health care system with better access, quality, and efficiency. In its initial five-year term, the Commission will track performance targets, develop policy options, and disseminate innovative practice changes to improve the U.S. health care system. In 2006, the Commission will issue its first scorecard documenting the progress or lack thereof in achieving five, 10, and 15-year goals toward improving the health care system. Access the chartbook at: http://www.cmwf.org/publications/publications_show.htm?doc_id=302833 Back to top New AHRQ Program to Identify, Spread Effective Care The Agency for Healthcare Research and Quality (AHRQ) launched a three-part $15 million program designed to help clinicians and patients determine which drugs and other medical treatments work best for certain health conditions. Initial reports from the new program will be issued this Fall, with a focus on information relevant to the health of Medicare beneficiaries. The “Effective Health Care Program” (http://www.effectivehealthcare.ahrq.gov) involves 13 new research centers and a communications center that will support the development and dissemination of new scientific information through research on the outcomes of health care services and therapies, including drugs. The three program components include: Comparative Effectiveness Reports – developed from an existing network of 13 Evidence-based Practice Centers or EPCs, which focus on comparing the relative effectiveness of different treatments, including drugs, as well as identifying gaps in knowledge where new research is needed. Network of Research Centers – a network of 13 Developing Evidence to Inform Decisions about Effectiveness research centers (referred to as DEcIDE centers) will conduct research aimed at filling knowledge gaps about treatment effectiveness including the use, benefits, and risks of medications and other therapies. DEcIDE centers will use de-identified medical data for millions of patients, including Medicare’s 42 million beneficiaries. Making Findings Clear for Different Audiences – a Clinical Decisions and Communications Science Center, known as the Eisenberg Center, will work to translate findings to various audiences, including consumers, clinicians, payers, and health care policy makers. In addition, the Eisenberg Center, will conduct research to improve usability and rapid incorporation of findings into medical practice. “As the Medicare program moves toward the launch of its new drug benefit next year, it will be increasingly important to have sound information about which drugs and other treatments are proven to be effective for the conditions that are most important for our beneficiaries,” said Mark B. McClellan, MD, administrator of the Centers for Medicare & Medicaid Services. A Listserv is available on the Effective Health Care website to notify users of new reports and findings: http://www.effectivehealthcare.ahrq.gov. For more information, contact AHRQ Public Affairs: 301-427-1922. Back to top Case Review Linked with QI Leads to Substantial Improvement Florida Medical Quality Assurance, Inc. (FMAQI), the QIO for Florida, is making the case for linking case review activities and quality improvement projects. Using a collaborative approach, the QIO led one facility from sanction to the Joint Commission on Accreditation of Healthcare Organization’s Gold Seal of Approval. At the request of the Centers for Medicare & Medicaid Services (CMS), FMAQI began to review allegations of poor care at one of the state’s hospital-based cardiac surgery centers in late 2002. The QIO sent an initial sanction notice to the facility and cardiothoracic surgeons involved in early 2003. The notice prompted the provider and practitioners to enter into a corrective action plan (CAP), which involved reviewing internal processes to identify opportunities for improvement. Based on the identified opportunities, process strategies were employed, improvement plans developed, and monitoring criteria established. Improvement plans included: (1) completion of nursing assessment, (2) physician’s orders completed within a defined timeframe, (3) management of the patient’s post-operative weight gain with a goal of no more than 19 pounds, and (4) documentation of pre-operative laboratory studies on the patient’s chart. FMQAI reviewed medical records to validate the performance improvement activities initiated by the facility and practitioners. During the course of these reviews, FMQAI provided the facility with relevant information on the Surgical Infection Prevention indicators, which were eventually incorporated into their standard pre- and post-operative physician orders for cardiac surgery patients. The results of the medical record validation, along with the quarterly reports furnished by the health care provider and cardiothoracic surgeons were presented to FMQAI’s internal Quality Review Committee, which determined that no further action on the initial sanction notice would be necessary. The collaboration between FMQAI and the care providers, forged in the course of case review activities, led to such substantial transformation in quality that the Joint Commission on Accreditation of Healthcare Organization (JCAHO) recently recognized this major cardiac surgery program as the first hospital in Florida, and second in the nation, to receive JCAHO’s Gold Seal of Approval for coronary artery disease care. JCAHO says organizations that attain this certification “stand apart from the rest” because they have demonstrated a “continuum-based approach to chronic condition management” that: Supports a patient’s self management activities; Utilizes a standardized method of delivering or facilitating integrated and coordinated clinical care based on clinical guidelines or evidence-based practices; Tailors treatment and intervention to individual needs; Promotes the flow of patient information across settings and providers, while protecting patient’s rights, security and privacy Analyzes and uses data to continually improve treatment plans; and Evaluates ways to improve performance and clinical practice, thereby improving patient care. For more information, contact David Ruscitti at 813-865-3255. Back to top Leavitt Sets Agenda for American Health Information Community During the first meeting of the American Health Information Community, Secretary of Health and Human Services Mike Leavitt, who chairs the Community, called for an improved national bio-surveillance system. The Community is a diverse group of 17 individuals representing government, health care providers and payers, consumers, technology, and business. It is expected to be a “network of networks” that will provide advice and recommendations “that allow health IT vendors and purchasers to confidently move forward with certainty and coordination,” said Leavitt. “Moving in the right way will require the private sector to be involved. Without the advice of private purchasers, payers, providers and patients, it’s likely that government would make mistakes, create unintended consequences and miss innovative opportunities.” In his remarks to the new Community, Leavitt explained that their recommendations would carry “significant weight” and that he and other government representatives “will identify the means to accomplish the results that the Community seeks” in order to “change the way the health care market operates.” In some cases, this may involve using the National Institute of Standards and Technology to implement government-wide change. Leavitt said it is a national priority for the first breakthrough work group convened by the Community to consider ways to improve bio-surveillance in preparation for pandemics and bioterrorism. “I want a system that will stream emergency room data from local, state and national health authorities multiple times a day. And, I want this operational by the end of 2006,” said Leavitt. Read Secretary Leavitt’s comments at: http://www.hhs.gov/news/press/2005pres/20051007.html The Community: http://www.hhs.gov/healthit/ahic.html Back to top HHS Awards $17.5 Million to Improve EHRs Three public-private organizations have received contracts totaling $17.5 million from the Department of Health and Human Services (HHS) to create partnerships that will develop a standards harmonization process, a compliance certification process, and privacy and security solutions to accelerate the adoption of health information technology and the secure portability of health information across the country. The partnerships will deliver reports to the American Health Information Community, a new federal advisory committee chaired by Secretary Leavitt and charged with providing recommendations to HHS on how to make health records digital and interoperable. American National Standards Institute (ANSI), a non-profit organization that administers and coordinates the U.S. voluntary standardization activities was awarded $3.3 million to convene the Health Information Technology Standards Panel (HITSP). The HITSP will bring together US Standards Development Organizations (SDOs) and other stakeholders. The HITSP will develop, prototype, and evaluate a harmonization process for achieving a widely accepted and useful set of health IT standards that will support interoperability among health care software applications, particularly EHRs. Certification Commission for Health Information Technology (CCHIT) was awarded $2.7 million to develop criteria and evaluation processes for certifying EHRs and the infrastructure or network components through which they interoperate. CCHIT is a private, non-profit organization established to develop an efficient, credible, and sustainable mechanism for certifying health care information technology products. Recommendations for ambulatory EHR certification criteria are expected in December 2005; an evaluation process for ambulatory health records is expected in January 2006. RTI International, a private, nonprofit corporation, was awarded $11.5 million to oversee the work of the Health Information Security and Privacy Collaboration (HISPC), a new partnership consisting of a multi-disciplinary team of experts and the National Governor's Association (NGA). HISPC will work with state governments to assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices which may pose challenges to interoperable health information exchange. A fourth RFP, for development of nationwide health information network (NHIN) architectures, will be awarded to one or more contractors later in 2005. Back to top JAMA Study Looks at P4P Impact on Quality The first study to assess the effects of a pay-for-performance program in a large health plan found significant quality improvement in a physician group with a quality incentive program (QIP) for one of the three clinical measures studied, compared with a physician group without a QIP. While quality also improved in the other two measures, the differences between the two groups for these measures were not significant. Some of the media coverage noted that most of the bonus money in the program went to physician groups that performed well at baseline, rather than those that improved the most during the course of the project. The findings are published in the October 12th issue of the Journal of the American Medical Association, in “Early Experience with Pay-for-Performance: From Concept to Practice,” by Meredith B. Rosenthal of Harvard School of Public Health and colleagues. The research was supported by The Commonwealth Fund. The Fund was positive about the significance of the findings. “There is widespread consensus that existing financial incentives in the U.S. health care system are misaligned and fail to reward high quality.” said Commonwealth Fund president Karen Davis. “It is encouraging to see some initial evidence that rewarding good performance can lead to improved systems.” The study compared quality improvements for clinical quality scores on Pap smears, mammography, and hemoglobin testing for diabetics in two groups in a large health plan, PacifiCare Health Systems. PacifiCare’s California network, which implemented a quality incentive program in 2003, was compared with PacifiCare’s Pacific Northwest group (in Oregon and Washington) which did not participate in a quality incentive program. The California medical groups received bonuses for meeting specific targets in clinical quality scores. The researchers found that quality scores for cervical cancer screening improved 5.3% in the pay-for-performance group, compared with 1.7% in the group without pay-for-performance, a significant difference. For the other two measures studied, mammography and hemoglobin testing for diabetics, the difference was not significant. Researchers also found that 75% of the bonus payments went to the physician groups whose performance was above the bonus threshold before the QIP was implemented. “This research provides important data about how incentives can best be structured to foster quality of care,” said Anne-Marie Audet, MD, vice president at the Fund. “Rosenthal’s findings can really inform current debates about still unresolved issues such as what level of financial incentive is needed to produce the desired effect, or whether absolute performance targets or relative improvement levels should be rewarded.” An abstract of the article is available at: http://jama.ama-assn.org/cgi/content/short/294/14/1788 Back to top AHRQ Awards Health IT Implementation Grants The Agency for Healthcare Research and Quality (AHRQ) announced the award of more than $22.3 million to 16 grantees to implement health information technology (health IT) systems to improve the safety and quality of health care. The grants are an expansion of health IT funding provided in 2004, and will allow the 16 recipients to carry out the plans they developed in their earlier grants. The projects focus on sharing health information between providers, laboratories, pharmacies, and patients to ensure safer patient transitions between health care settings, as well as reduce medication errors and duplicative testing. Some examples: At Franklin Foundation Hospital in coastal Louisiana , safety net health care providers will integrate health information and communications systems to support chronic disease management, improve patient safety and eliminate duplication of effort. The University of Tennessee and its partners will develop an integrated electronic health record for children with special health care needs to improve the coordination of services, continuity of care, timeliness of follow-up services and patient tracking. Chadron Community Hospital in Nebraska will implement a regional health information exchange for an established network of rural hospitals, clinics and providers across a 14,000-square-mile remote area of Nebraska . The Holomua project in Hawaii will implement a health IT system to improve the flow of information among patients, community health centers and hospitals serving ethnic minorities, immigrants and other vulnerable populations during transitions of care between primary and tertiary care facilities. “These grantees started from scratch, many in rural and underserved areas, and in less than a year they’ve laid the groundwork to build valuable health IT systems in their communities,” said AHRQ Director Carolyn M. Clancy, MD. For a complete list of the awardees: http://www.ahrq.gov/news/press/pr2005/hitimppr.htm#hitgrants#hitgrants Back to top HHS Grants to Help Underserved in Katrina-hit Areas The Department of Health and Human Services (HHS) has announced the award of more than $12 million in grants to support individuals, families, and children affected by the devastation caused by Hurricane Katrina. The grants will support greater access to health and behavioral health care services, assistance through faith-based and community organizations, and enhanced communications through minority media outlets. Larger grants will go to: The HHS/National Institutes of Health/National Center on Minority Health and Disparities centers of excellence in the Gulf Coast and surrounding states to support innovative approaches to relief activities, including culturally relevant mental health services, bringing electronic health records to mobile units and other such activities. State Offices of Minority Health to support efforts to improve the health and well-being of racial/ethnic minorities in particular those affected by Hurricane Katrina. Back to top CMS to Fight Fraud in Rx Benefit The Centers for Medicare & Medicaid Services (CMS) announced a three-pronged approach for combating fraud in the new prescription drug benefit. CMS has awarded contracts to eight organizations that will monitor and analyze data to help identify problems. The agency will also work with law enforcement, prescription drug plans, consumer groups, and other key partners to protect consumers and enforce Medicare’s rules; and provide basic tips for consumers so they can protect themselves. A fact sheet is available to help beneficiaries learn how to protect themselves “Quick Facts About Medicare Prescription Drug Coverage and Protecting Your Personal Information,” is at http://www.medicare.gov/Publications/Pubs/pdf/11147.pdf Back to top QIOs Awarded Contracts to Help Fight Fraud At the heart of CMS’ approach to fighting fraud is the designation of eight new Medicare Rx Integrity Contractors (MEDICs) that are uniquely positioned to find fraud, waste, and abuse in the new prescription drug program. The eight MEDIC contracts have been awarded to: Electronic Data Systems Corporation, Livanta, LLC, Maximus Federal Services, Inc, NDCHealth, Perot Systems Government Services, Inc., Science Applications International Corporation, and two QIOs: Delmarva Foundation for Medical Care, Inc., the Maryland QIO, and IntegriGuard, LLC, a subsidiary of Lumetra, the California QIO. Each MEDIC will: Analyze data to find trends that may indicate that fraud or abuse is being conducted; Investigate potential fraudulent activities surrounding enrollment, eligibility determination or distribution of the prescription drug benefit;  Investigate unusual activities that could be considered fraudulent as reported by CMS, contractors, or beneficiaries; Conduct fraud complaint investigations; and Develop and refer cases to the appropriate law enforcement agency as needed.  CMS will also be working closely with the Administration on Aging’s Senior Medicare Patrol Program, providers, Medicare contractors, and other government agencies, including the Department of Health and Human Services Office of the Inspector General, Federal Bureau of Investigation, Department of Justice, States’ Attorneys General, and the State Medicaid Fraud Control Units. Beneficiary concerns about the new benefit can be directed to 1-800-MEDICARE. Fraud suspicions should be directed to local law enforcement or the Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS. Back to top Proposed Legislation Would Create New Office of Patient Safety and Health Care Quality at HHS Senator Hillary Rodham Clinton (D-NY) and Barack Obama (D-IL) have introduced the National Medical Error Disclosure and Compensation Act, which would create an Office of Patient Safety and Health Care Quality under the Department of Health and Human Services. The Office would work in collaboration with the Agency for Healthcare Research and Quality to increase patient safety and health care quality across health care settings. The Office would be responsible for creating a National Patient Safety Database, conducting data analyses to inform policy and practice recommendations for providers, establishing and administering the National Medical Error Disclosure and Compensation (MEDiC) Program, and supporting a number of studies related to MEDiC and the medical liability system. The MEDiC Program would be designed to improve the quality of health care by encouraging open communication between patients and health care providers; reducing rates of preventable medical errors; ensuring patients have access to fair compensation for medical injury, negligence, or malpractice; and reducing the cost of medical liability insurance for doctors, hospitals, health systems, and other health care providers. For details of the proposed legislation, visit: http://www.clinton.senate.gov/documents/092805sectionbysection.pdf Back to top Survey: Slow Implementation of HIT in Hospitals Results of a survey released by the American Hospital Association indicate that 9 out of 10 hospitals are using or considering adopting health information technology (HIT) for clinical uses. But most hospitals, especially small or rural hospitals, cite cost as a considerable barrier to broader implementation and only 10% of the surveyed hospitals have fully implemented IT systems. The survey of more than 900 hospitals was administered to hospital CEOs from April to June 2005.  It showed that most hospitals are in the beginning stages of making investments in IT to make gains in the safety and quality of patient care.  Some of the technologies and systems hospitals are using include bar coding devices, computerized physician order entry and electronic health records (EHR). Factors such as hospital size and location are related to the level of use, as is a hospital’s financial status. Hospitals with the greatest use of IT had higher average margins, and those with positive margins use more IT. Those that reported the least amount of IT use plan on spending a greater share of capital on IT in the future.  Among surveyed hospitals, 53 percent reported sharing patient specific information with physician offices, laboratories and even school clinics to improve coordination of care. The report can be viewed online at http://www.ahapolicyforum.org/ahapolicyforum/reports/index.html Back to top NCQA Report Ranks Health Plans The quality of care delivered by health plans improved markedly in many key areas in 2004, but only about 21.5 percent of the industry now reports publicly on its performance, according to NCQA’s annual State of Health Care Quality report. This year, NCQA teamed up with U.S. News & World Report to create new rankings of America ’s Best Health Plans. Rankings are based on clinical performance, member satisfaction, and NCQA Accreditation information. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures; Medicare and Medicaid plans reported smaller gains. The report finds that as many as 67,000 deaths have been prevented to date as a result of improvements recorded over the past six years. Especially notable this year were improvements in measures related to high blood pressure control (up 4.6 points to 66.8 percent) and cholesterol control for people with diabetes (up 4.4 points to 64.8 percent). The report is available on the U.S. News & World Report website, print edition, and on NCQA’s website. (http://www.usnews.com/healthplans). Printed versions of the report can be purchased at (888) 275-7585. Back to top Studies Indicate Preventive Measures Working for Heart Care New research studies show a decrease in the number of heart attacks and cholesterol levels in Americans, suggesting that preventive therapies may be working. In the October 12 issue of the Journal of the American Medical Association, Margaret Carroll, MSPH, of the Centers for Disease Control and colleagues examined trends in lipids between 1960 and 2002. They found decreases in LDL, most significantly in women over 50 and men over 60, while HDL remained the same. Triglyceride levels also decreased. In addition, the age-adjusted percentage of adults 20 years or older with serum total cholesterol level of at least 240 decreased from 20 percent to 17 percent. The authors suggest that cholesterol-lowering medications likely contributed to the decrease in total and LDL levels. Read an abstract of the JAMA study at: http://jama.ama-assn.org/cgi/content/abstract/294/14/1773 In another study, researchers from Quest Diagnostics analyzed 80 million laboratory tests and found that LDL cholesterol fell about 10% from 2001 to 2004. Information on this study is available at: http://www.questdiagnostics.com/ And a study of hospital admissions done by Solucient LLC, a health-data company in Evanston, IL, found that of more than 55% of all hospital discharges, admission rates for heart attacks decreased by more than 6% since 2000. Back to top

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