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GAO Releases
Report on Nursing Homes QIO Partners
with State Agency to Assist Enrollment in Part D HCAHPS
Training in Early February: Register by January 27 CMS Awards
First Contracts for Streamlined Claims Processing Under MMA AHRQ/NCI
to Hold 2006 TRIP Conference in July Seminar
on Culture Change at AHQA Annual Meeting Call for
Presentations at Health Literacy Meeting AHRQ Releases
2005 Reports on American Health Care; Faster Improvement Seen Where
QIOs Assist Providers At the National
Leadership Summit on Eliminating Racial and Ethnic Disparities in Health,
the Agency for Healthcare Research & Quality (AHRQ) released findings
from the 2005 National Healthcare Quality Report (NHQR) and its companion
document, the 2005 National Healthcare Disparities Report (NHDR). 2005 Quality
Report “The
2005 report shows that there has been much more rapid improvement in
some measures, especially where there have been focused efforts to
improve performance. For example, measures for heart attack, heart
failure and pneumonia showed an annual improvement of 9.2 percent.
These are priority areas for Medicare, where hospitals have received
special help from Medicare’s Quality Improvement Organizations” said
Carolyn Clancy, MD. Overall,
the quality report indicates that for most Americans, the quality of
health care continues to improve at a rate of 2.8 percent, as was shown
in last year’s report, with much more rapid improvement in some
measures. Greatest improvements were noted in quality measures for
diabetes, heart disease, respiratory conditions, nursing home care,
and maternal and child health care – all but one are target areas
for intensive efforts by QIOs. “Medicare’s
QIO measures for heart disease and pneumonia showed a combined rate
of improvement (9.2%) that was four times the combined rate for all
the other measures (2.5%)” said the report (see chart). For the
composite of these measures, the report shows “significant improvement
in the provision of recommended care for Medicare patients with heart
attacks from 77.2% of the opportunities to provide recommended care
in 2000-2001 to 82.1% in 2003.” The report
also finds a 10.2 percent annual improvement in the five core measures
of patient safety. These are areas where coordinated national efforts
by QIOs and others are underway to improve the delivery of specific “best
practice” treatments to improve patient safety and reduce medical
errors. This finding provides evidence that the spread and implementation
of best practices, the heart of QIO program initiatives, is paying
off. “Improvement
of less than 3 percent per year appears to be the secular trend, and
that is not nearly fast enough progress. The AHRQ report presents clear
evidence of the value of Medicare’s investment in the QIO program,” said
AHQA Executive Vice President, David Schulke. “A tripling of
the rate of improvement where the QIOs are active makes a strong case
for a much more serious investment in helping health professionals
implement best practices.” 2005 Disparities
Report Although
health care disparities are narrowing overall for many minority Americans,
disparities in both quality for care and access have widened for Hispanics. The report
also found that many of the largest disparities in measures of quality
and access are observed for low-income people regardless of race or
ethnicity. Overall, more racial disparities in quality of care were
narrowing than were widening, and most racial disparities in access
to care were narrowing (affecting blacks, Asians and American Indians/Alaska
Natives). For Hispanics, disparities widened in both access to and
quality of care. Examples
of other findings in the disparities report: 2006 Summit Improvement
rate for QIO measures versus Source:
2005 National Healthcare Quality Report The National
Leadership Summit on Eliminating Racial and Ethnic Disparities in Health,
held January 9-11, in Washington, DC, was sponsored by the Office of
Minority Health. Nearly 2000 individuals registered for the event. In addition
to the two AHRQ reports, Department of Health and Human Services Secretary
Michael Leavitt, announced several key initiatives during the summit: In the Media AHQA distributed
a news release announcing the results of the AHRQ quality report and
highlighting the report’s conclusion that the areas that received
focused efforts from QIOs resulting in more dramatic improvement. The
release cited the report’s findings that QIO measures for heart
attack care and pneumonia treatment improved greatly – “four
times the combined rate for all the other measures.” InsideHealthPolicy,
a publication widely read by Washington policy makers and the consumer
news wire, Reuters Health, both reported on the AHRQ report, highlighting
QIO involvement. Read AHQA’s news release: http://www.ahqa.org/pub/media/159_678_5295.cfm GAO
Releases Report on Nursing Homes The Government
Accountability Office (GAO) released a report “Nursing Homes:
Despite Increased Oversight, Challenges Remain in Ensuring High-Quality
Care and Resident Safety” (GAO-06-117), which found “significant
decline in the proportion of nursing homes with serious quality problems” but “inconsistency
in how states conduct surveys and understatement of serious quality
problems.” The report was conducted at the request of Senators
Charles Grassley (R-IA) and Herb Kohl (D-WI). “QIOs
did not get included with the criticisms of CMS that GAO charged in
this report,” notes AHQA government affairs director David Adler. “QIOs
generally were discussed in the context of things CMS has done to address
nursing home quality gaps. But we’ll have to wait several more
months for GAO’s final assessment on the effectiveness of QIO’s
efforts to improve nursing home care,” Adler said, adding that
AHQA staff have briefed GAO officials several times on QIO progress
in this area. In comments
to the media, CMS Administrator McClellan said the report shows that
the quality of nursing home care has improved in the last five years.
But McClellan added that these gains are in jeopardy because Congress
has not provided enough money and state budgets are limited for this
purpose. Dr. McClellan also said the Bush administration wanted to
link payment of nursing homes to the quality of care they provide and
that he expected to test such a pay for performance system this year. The GAO
did not attempt to evaluate QIO program efforts related to nursing
homes. However, it did note QIO involvement with nursing home quality
since 2002, citing CMS preliminary analyses of SOW7 data, which showed
that “the QIO program has helped to reduce the use of daily physical
restraints, increased management and treatment of pain, and reduced
the incidence of delirium among post-acute-care residents,” while “less
progress has been made in decreasing the prevalence of pressure sores.” GAO was
asked by Congress to assess CMS progress since 1998 in addressing oversight
weaknesses in nursing homes. The office reviewed trends in nursing
home quality from 1999 through January 2005 and evaluated the effectiveness
of CMS’s initiatives on survey and oversight problems. Then,
the office laid out key challenges to continued progress in improving
nursing home care. The report
finds that although CMS “has addressed many survey and oversight
shortcomings,” the agency has yet to implement “several
key initiatives, particularly those intended to improve the consistency
of the survey process.” GAO credits CMS with taking several steps
including: revising the survey methodology; providing states additional
guidance on complaint investigations; implementing immediate sanctions
for repeated, serious violations; and conducting assessments of state
survey activities. But, some of these initiatives, GAO said, “either
have shortcomings impairing their effectiveness or have not effectively
targeted problems.” The report also questioned CMS’ inability
to provide accurate data on the Nursing Home Compare website. Key challenges
GAO identified for CMS include: the cost to update older homes with
automatic sprinklers; hiring of qualified surveyors; and an expanded
workload due to increased oversight, additional providers, and more
competing initiatives. CMS has “generally concurred” with
the report’s findings. QIO Partners
with State Agency to Assist Enrollment in Part D The Carolinas
Center for Medical Excellence (CCME), North Carolina’s QIO, is
helping Medicare beneficiaries enroll in appropriate drug plans. Partnering
with The North Carolina Department of Insurance Seniors Health Insurance
Information Program (SHIIP), QIO staff are entering sensitive health
information provided on paper by beneficiaries into Medicare’s
electronic “plan finder tool,” which compares drug plan
options based on prescribed medications. SHIIP serves
as the lead agency in the state to educate, counsel, and enroll beneficiaries
in the new Medicare Part D Program. Through community volunteers, expert
staff, and a statewide consumer hotline, SHIIP is assisting hundreds
of senior citizens, their families and other Medicare beneficiaries
enroll in the new Medicare benefit on a daily basis. The current
push by the Centers for Medicare & Medicaid Services (CMS) and
others to enroll seniors in the new drug benefit has put a huge demand
on SHIIP resources. “They
have had so many people seek counseling—that they can’t
keep up with all the paper,” said Peg O’Connell, JD, CCME
Director of External Relations. “This is not just the case in
NC—it is country wide,” she said. When the
increased demand for SHIIP assistance hampered Medicare beneficiaries’ ability
to select and enroll in the appropriate drug plan in a timely manner,
SHIIP approached its long-time partner, CCME, for assistance. “SHIIP
has been a good partner of ours for many years and they asked us to
help,” said O’Connell. “More importantly, this will
help our state’s Medicare beneficiaries get the information they
need to make a good choice about a Part D Plan.” The CCME
Board set aside $10,000 in private (non-Medicare) funds from CCME reserves
to pay its staff to enter beneficiary health information into Medicare’s
online drug plan finder tool and send plan comparison results to SHIIP
counselors who can help beneficiaries enroll. Fifteen CCME staff, experienced
in working with and protecting personal health information, will work
on this project before or after their regular hours or on weekends.
CCME’s QIO contract will not be charged for this work and staff
will only use non-SDPS computers for the project. “CCME
and other QIOs across the country who are engaging in similar efforts
to support their partners and assist beneficiaries in Part D enrollment
should be commended,” said David Schulke, AHQA EVP. “It’s
not only the right thing to do – it shows the unique skills and
value that QIOs provide to Medicare beneficiaries beyond the CMS contract.” HCAHPS
Training in Early February: Register by January 27 The Centers
for Medicare & Medicaid Services (CMS) announced that it will begin
training for the CAHPS Hospital Survey (HCAHPS) in early February.
HCAHPS was created to uniformly measure and publicly report patients’ perspectives
of their inpatient care. Vendors
that administer HCAHPS for their hospital clients and hospitals that
conduct the survey on their own must attend a one-day training session
at CMS headquarters in Baltimore, either February 2nd or 3rd or participate
in two half-day, internet-based Webinar training sessions: Part 1 on
February 6th or 8th and Part 2 on February 7th, 9th, and 10th. Training
is free but participants must register online by January 27 at: www.hcahpsonline.org. A short “dry
run” of HCAHPS is planned after training. The dry run will enable
hospitals/vendors to use the official survey instrument, approved survey
modes, and data collection protocols and report to CMS -- without public
reporting. All hospitals that intend to participate in the national
implementation of HCAHPS in fall 2006 must take part in a dry run. National
implementation of HCAHPS for public reporting purposes will begin with
a nine month collection period resulting in aggregate data published
on the Hospital Compare website, www.hospitalcompare.hhs.gov in late
2007. HCAHPS is
being implemented nationally by the Hospital Quality Alliance (HQA),
a partnership of federal agencies, hospital organizations, consumer
and employer groups, clinicians, and other key national groups. CMS Awards
First Contracts for Streamlined Claims Processing Under MMA The Centers
for Medicare & Medicaid Services (CMS) has awarded four contracts
for Durable Medical Equipment Medicare Administrative Contractors (DME
MACs) that will be responsible for handling the administration of Medicare
claims from suppliers of durable medical equipment, prosthetics, and
orthotics. DME MACs will replace the current Durable Medical Equipment
Regional Carriers (DMERCs) as part of contracting reform provisions
of the Medicare Modernization Act of 2003. The new
structure means that beneficiaries and providers will eventually have
a single point of contact with the Medicare program -- DME MACs for
all Medicare providers, and Beneficiary Contact Centers for beneficiaries.
Currently, fiscal intermediaries process claims for Part A providers
such as hospitals, skilled nursing facilities, and other institutional
providers while carriers process claims for physicians, laboratories
and other suppliers under Medicare Part B. DME MACs will be responsible
for both Part A and Part B claims. The DME
MAC contracts, which have a combined potential value of $542 million,
are the first of 23 that will be awarded by 2011. Each contract includes
a base period with four 1-year options and will be competed every five
years. DME MAC performance will be judged on: enhanced provider customer
service, increased payment accuracy, improved provider education and
training leading to correct claims submissions, and realized cost savings
resulting from efficiencies and innovation. DME MACs
will assume full responsibilities for the claims processing work currently
performed by the DMERCs on July 1, 2006. For more
information, see: http://www.cms.hhs.gov/MedicareContractingReform/ AHRQ/NCI
to Hold 2006 TRIP Conference in July The conference
will provide an opportunity for health services researchers, clinicians,
health care managers, payers, patient and consumer representatives,
industry representatives, and policy makers to share innovative TRIP
research and implementation methods, case studies and other experiences. A call
for abstracts will begin January 20 and will remain open until March
3, available at: http://www.epc3.net/TRIPP06/abstract/ Additional
conference information, including registration, hotel, and meeting
agenda will be available on the conference website, which goes live
late February or early March. Seminar
on Culture Change at AHQA Annual Meeting A one-day
workshop on culture change will be offered at the 2006 AHQA Annual
Meeting in Miami from 8 AM to 4 PM on two days, February 22 and 23.
The workshop will provide a hands-on learning experience for QIO staff
and others interested in learning more about resident-centered care. Designed
as a trainer’s clinic, it will include a workbook and a new video
produced by Action Pact and the American Health Quality Foundation:
A Tale of Tranformation: Four Stages Tell the Story to explore the
stages of culture change. Through exercises and activities, the session
provides an opportunity to see various tools in action, discover new
applications of the materials, and raise consultant and trainer issues
in moving organizations toward resident centered care. Both workshops
will be led by LaVrene Norton, MSW, Executive Leader of Action Pact,
Inc. Preference for the February 22 workshop will given to QIO staff
attending the nursing home QIOSC training on February 20, 21. Only 25
participants will be able to attend each day. Registration can be done
concurrent with registration for AHQA’s annual meeting at www.ahqa.org. Call
for Presentations at Health Literacy Meeting The American
College of Physicians Foundation (ACPF) recently called for submissions
for presentations at the 2006 Fifth Annual National Health Communication
Conference, a series of conferences that focuses on problems of low
health literacy. Presentations
are expected to focus on research and supporting data on solutions
for patient-centered programs to improve health literacy. Topics for
consideration include, but are not limited to: Submissions
should be submitted electronically by February 16, 2006 to Jonathan
Uhl at juhl@acponline.org. Proposals should be in Microsoft Word format,
organized into sections describing Background, Methods, Results, and
Conclusions with a clear description of the target population, and
should be no longer than 500 words. All authors/presenters should be
listed. Lead presenters can submit no more than two proposals. For more
information, http://foundation.acponline.org/news.htm or contact Jonathan
Uhl at 877-208-4189.
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