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CMS Takes First Step in Physician Reporting Significant Improvement Seen in Nursing Home Special Study CMS Requires Hospitals to Adopt New Cardiac Registry for Quality Data Health Affairs Articles Discuss Efficiency, Cost of Care AHRQ Hosting a Series Teleconference on HIT Medicare Announces Payment Changes; Cancer Demo AHCA/NCAL Announce 2005 Quality Award Recipients AMA Develops Tool Kit for 100K Lives First Participants Selected for VNAA CHAMP Program AMA Calls for Volunteers to Field-test Patient Centered Communication
Tool Kit CMS Takes First Step in Physician Reporting The Centers
for Medicare & Medicaid
Services (CMS) recently announced a major initiative to promote data
collection and reporting on quality of care from physician offices
— the Physician Voluntary Reporting Program (PVRP). The voluntary program allows physicians to report information about
the quality of care they provide to Medicare beneficiaries via claims
data and receive feedback from CMS. The program drew strong criticism
from the Medical Group Management Association (MGMA) and American Medical
Association (AMA). Reporting is to begin in January 2006. Thirty-six evidence-based measures will be included in the first phase
of PVRP. The measures are based, in part, on the work of the National
Quality Forum (NQF), the Ambulatory Care Quality Alliance, the AMA Physician
Consortium for Quality Improvement, the National Committee for Quality
Assurance (NCQA) and RAND. In a press release, CMS said that it relied
heavily on the NQF measures because the organization is a primary consensus-development
body for health care quality measures. Additional quality measures may
be phased in during the year. G-codes Physicians will register for the program via QNet Exchange and will
receive feedback from CMS posted to that site by the summer of 2006.
CMS will also seek input from participating physicians on ways to improve
the ease of reporting and usefulness of the quality measures. MGMA, AMA Respond Also in
a letter to McClellan, the AMA Board of Trustees called for the agency
to “rescind” the PVRP project, calling for a “meeting
between you and physician leaders that leads to meaningful dialog.” The
AMA reiterated the concerns of MGMA, citing “excessive administrative
requirements” that “could doom this initiative and negate
any intended quality improvements.” It also noted that physicians
have made “good faith efforts” to work with CMS and others
to develop thoughtful and appropriate physician performance measures.
(Read the AMA letter: http://www.ama-assn.org/meetings/public/interim05/bot19i05.pdf) Congresswoman Nancy Johnson (R-CT), Chair of the House Ways and Means
Subcommittee on Health, introduced legislation designed to foster adoption
of national electronic medical records and e-prescribing systems to improve
health care quality across the nation. The bill, “Health Information Technology Promotion Act of 2005” (H.R.
4157), has 31 co-sponsors and is supported by the eHealth Initiative,
Disease Management Association of America, American Health Information
Management Association, National Council for Community Behavioral Healthcare,
American Medical Group Association, Healthcare Leadership Council, and
the Federation of American Hospitals. Johnson’s proposal includes several key elements including making
permanent the national health IT coordinator’s post, currently
held by David Brailer, MD, PhD, while defining clear roles and responsibilities
for the position. The legislation would also require Secretary Leavitt
to report to Congress within two years on the progress of the public-private
American Health Information Community initiative and the development
of a strategic plan to coordinate the implementation of a health IT infrastructure. In addition,
the bill adopted recommendations of the bipartisan, congressionally
appointed Commission on Systemic Interoperability. Johnson’s
proposal: “Information technology, e-prescribing and electronic medical
records have the ability to improve health care quality, reduce errors
and save lives,” Johnson said. “America’s health care
system has lagged behind other sectors in maximizing its use of cutting-edge
information systems, but now we are moving full speed ahead.” Significant Improvement Seen in Nursing Home Special Study Quality
Partners of Rhode Island, the state’s QIO, and the Colorado
Foundation for Medical Care, Colorado’s QIO, recently hosted the
Improving Nursing Home Culture (INHC) Outcomes Congress to showcase the
results of a CMS special study that included two national pilots — the
Person-Directed Care (PDC) pilot and the Workforce Retention (Workforce)
pilot. During the last year, 21 QIOs and 168 nursing homes (representing 21
small groups of nursing home providers in each state that partnered with
their state QIO) worked on the PDC pilot while seven nursing home corporations
and 86 nursing homes worked on the Workforce pilot. The goal of the PDC
pilot was to bring care decisions as close to the resident as possible,
while participants in the Workforce pilot attempted to reduce workforce
turnover. Person-Directed Care Workforce Retention The Workforce Retention pilot nursing homes also experienced some impressive
improvements in quality measure rates. From the first quarter of 2004
to the first quarter of 2005, 86 nursing homes saw a 14% relative decline
in pain (chronic care population) from 6.32 to 5.44. In addition, this
group of nursing homes experienced a 9% relative decline in use of physical
restraints from 6.51 to 5.94. Among the post-acute care elders, a 25%
relative decline was noted in delirium. Impact on Residents For more
information about the INHC Special Study and Outcomes Congress, visit:
www.qualitypartnersri.org. The November
9 issue of the Journal of the American Medical Association includes
an article by staff at HealthInsight, Utah’s QIO; Qualis
Health, the QIO for Washington, Idaho, and Alaska; and staff at the
University of Utah. The article, “Clinical Decision Support
Improves Appropriateness of Antimicrobial Prescribing: Results
of a Rural Community Randomized Trial,” showed that a clinical
decision support system (CDSS) effectively reduced inappropriate
antibiotic prescribing. Through
a cluster randomized trial, researchers measured the added value of
a CDSS by applying its use to target groups in conjunction with community-wide
intervention to reduce inappropriate prescribing for acute respiratory
infections. They found that the CDSS group decreased unnecessary use
of antibiotics for viral respiratory tract infections and improved
antibiotic selection. Specifically, the authors state that “the
relative decrease in antimicrobial prescribing for visits in the antibiotics ‘never-indicated’ category
during the post-intervention period was 32% in CDSS communities
and 5% in community intervention-alone communities.” CDSS was
effective whether applied in paper form or a handheld computer. Read
the full article at: http://jama.ama-assn.org/cgi/content/full/294/18/2305 CMS
Requires Hospitals to Adopt New Cardiac Registry for Quality Data The Centers
for Medicare & Medicaid
Services (CMS) has contracted with the American College of Cardiology
(ACC) to collect nationwide data to learn more about the use of implantable
cardioverter defibrillators (ICDs) for primary prevention of sudden
cardiac death among Medicare beneficiaries. The ACC’s National Cardiovascular Data Registry’s
(ACC-NCDR) ICD Registry was developed through a partnership between
the American College of Cardiology and the Heart Rhythm Society with
support from the ICD manufacturing industry, private health plans and
payers, and hospital groups. Hospitals will be required by CMS to transition
their current ICD data reporting activities from Quality Network Exchange
ICD Abstract Tool (QNET) to the ICD Registry no later than April 1,
2006. To ensure that hospitals can begin using the ICD Registry before the
ICD Abstraction Tool sunsets, hospitals must contact ACC-NCDR no later
than January 1, 2006, to begin the enrollment process. More information
about the ICD Registry can be found at https://www.accncdr.com or by
calling the American College of Cardiology toll-free at 1-800-253-4636,
extension 451. Health Affairs Articles Discuss Efficiency, Cost of Care Six-Country Study Finds US Lacking Some key findings include: Read the article at: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509. HIT Could Save More than $81 Billion Annually The Centers for Medicare and Medicaid Services (CMS) recently announced
a new demonstration project in which Medicare Advantage plans and dialysis
providers will partner to offer health plans to beneficiaries with ESRD.
The project is designed to test the effectiveness of disease management
models to increase quality of care for ESRD patients while ensuring that
this care is provided more effectively and efficiently. As part of the demonstration, CMS will also institute a pay-for-performance
model. The agency will reserve five percent of the capitation payment
rates for incentive payments related to quality improvement. Participating
organizations will receive payment for improvement on past performance
and performing above the national averages for quality measures related
to dialysis. Plans in
the demonstration project will be offered in parts of four states:
California, Texas, Pennsylvania, and Massachusetts. Beneficiaries will
be able to enroll in these new plans beginning November 15 with coverage
beginning January 1, 2006. For more information: http://www.cms.hhs.gov/researchers/demos/esrd_demo.asp. The Centers
for Medicare & Medicaid Services (CMS) recently released
the final Hospital CAHPS (HCAHPS) survey instrument. The HCAHPS survey
is the first national attempt to standardize patients’ satisfaction
with care in order to make “apples to apples” comparisons. Hospitals will begin using HCAHPS through the Hospital Quality Alliance,
a private/public partnership that includes the American Hospital Association,
the Federation of American Hospitals, and the Association of American
Medical Colleges, Joint Commission on Accreditation of Healthcare Organizations,
National Quality Forum, AARP, and CMS/AHRQ, and other stakeholders. Participation
by hospitals will be voluntary and results will be publicly reported
on the HHS Hospital Compare website. The final survey instrument was published in the November 7 Federal
Register. After a 30-day comment period, which closes on December 7,
the Office of Management and Budget will have 30 days to approve it.
CMS expects to begin national implementation in 2006. For more information on HCAHPS and CMS: http://www.cms.hhs.gov/regulations/pra/. AHRQ Hosting a Series Teleconference on HIT The National Resource Center for Health Information Technology, part
of the Agency for Health Research and Quality (AHRQ,) is hosting a series
of free teleconferences for health care providers interested in using
electronic health records (EHR). For more information and registration: https://nrc.webex.com/nrc/mywebex/default.php?Rnd8040=0.3415335993562853 Medicare Announces Payment Changes; Cancer Demo The Centers
for Medicare & Medicaid
Services (CMS) announced a final rule expands Medicare coverage of
glaucoma screening and access for rural beneficiaries enrolled in Medicare
Advantage plans to services of federally qualified health centers (FQHC);
adopts a modified approach to reforming payment for multiple imaging
procedures performed on a beneficiary at one session; and revises payment
for inhalation therapy and end stage renal disease (ESRD) treatment.
The final rule will be effective for services provided on or after
January 1, 2006. Under the new rule, glaucoma screening will be expanded to include Hispanic-Americans
age 65 and older because they are identified as an ethnic group at high
risk for the disease. Currently, this benefit is limited to individuals
with diabetes, those with a family history of glaucoma, and African-Americans
age 50 and over, another group with a propensity to develop glaucoma. The rule also calls for CMS to establish a new cancer quality demonstration
that focuses on treatment provided to beneficiaries for any of 13 cancers
listed as a primary diagnosis. This demonstration, which will be conducted
throughout calendar year 2006, will use the CMS billing system to generate
information on coordination of care, treatment design, and patient monitoring. Additional highlights of the new rule include: For more information: www.cms.hhs.gov/physicians/default.asp AHCA/NCAL Announce 2005 Quality Award Recipients The American Health Care Association (AHCA) and the National Center
for Assisted Living (NCAL) announced the 2005 AHCA/NCAL Quality Award
recipients at their annual conference, October 16-19 in Las Vegas. In
2005, 123 facilities were recognized with the Step I Award, an additional
10 facilities received the Step II Award, and 1 facility, Heritage Hall
East in Agawam, Massachusetts, earned the Step III Award. Modeled after the Malcolm Baldrige National Quality Award, the AHCA/NCAL
quality award program is designed to encourage continuous learning about
quality: “This type of process requires facility leadership to perform
a critical review of their processes and how strategy, personnel and
operations all fit together,” said Kevin Warren, Vice President
of Quality Improvement at TMF Health Quality Institute. AHQA nominated
Warren and Meg Richards, PhD, Senior Scientist at Quality Partners
of Rhode Island to serve as examiners for the 2005 award. Warren said the top three things that QIOs can do to help their long
term care partners prepare for the award are: 1. Document processes In addition to public recognition at the AHCA/NCAL national convention,
winners may freely use the AHCA/NCAL Quality Award gold seal on letterhead,
business cards, brochures, and other marketing materials. See a list
of 2005 winners: http://www.ahca.org/quality/awardwinners2005.htm Application deadline for the 2006 awards is March 31, 2006. For more
information: http://www.ahca.org/quality/awardapps.htm AMA Develops Tool Kit for 100K Lives As a strategic partner in Institute for Healthcare Improvement (IHI)
100,000 Lives Campaign, the American Medical Association recently launched
two online tools kits to encourage physicians to join the initiative.
More than 2800 hospitals are already participating. The “Making Strides in Safety” program
(www.ama-assn.org/go/makingstrides) stresses that working as a team
with support from hospital administration, medical staff, executives,
and other personnel is key to success. The 100,000 Lives Campaign offers
physicians the opportunity to take the lead in improving hospital care
for patients on a community and national level. American
Medical News, a membership publication of the AMA noted that the new
tool kids are “only part of the AMA’s most recent
efforts to help doctors get involved in formal patient safety efforts.” The
AMA co-sponsored “Moving from the Sidelines to the Frontlines of
Patient Safety: Empowering the Medical Staff” with the Joint Commission
Resources in September and October. First Participants Selected for VNAA CHAMP Program The Visiting Nurse Associations of America (VNAA) recently announced
the names of the first 15 home health agencies that have been accepted
into the VNAA Curricula for Homecare Advances in Management and Practice
(CHAMP) pilot program. Funded by The Atlantic Philanthropies, CHAMP is
a ground-breaking pilot practice improvement program designed to embed
in home health agencies the capacity for continuous practice improvement. The first group of pilot CHAMP participants represents states in New
England. Review is ongoing to select additional pilot participants from
California; those home health agencies in Iowa, Minnesota, and Wisconsin
have until November 14, 2005 to submit an application available at www.vnaa.org/champ. CHAMP provides
frontline nurse managers specialized management training and tools
to facilitate the field nurse’s acquisition of select
best practices to improve geriatric care. In addition to the first topic,
Medication Management, the 10-month pilot training program includes: See a list
of selected agencies here: http://www.vnaa.org/vnaa/MemberUpdate/ArticleDisplay.aspx?ArticleID=1410 AMA Calls
for Volunteers to Field-test Patient Centered Communication Tool Kit The
Ethical Force Program, a collaborative effort to develop health care
system-wide performance measures for ethics, is seeking participants
to field-test a tool kit on patient-centered communication with diverse
populations. Led by the American Medical Association, the program aims
to overcome communication barriers that are prevalent in vulnerable
minority populations with the expectation of reducing racial and ethnic
disparities in health care. Eight hospitals
and eight large physician practices will be selected from across the
country to field-test the patient-centered communication tool kit.
Selections will be based on interest in patient communication, desire
to assess current communication practices, willingness to receive a
one day site visit, and organizational demographics. Selected sites
will have the opportunity to: Small
grants will be available to select physician groups and hospitals
to defray some costs of participation. For more information: http://www.ama-assn.org/ama1/pub/upload/mm/369/toolkitappinfo.doc The
deadline for applications has been extended to November 25. To apply:
http://www.ama-assn.org/ama/pub/category/15604.html  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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