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Report Finds QI Efforts Improve Antibiotic Prescribing AHQA Adopts
Standards for QIO Organizational Integrity CMS Revises
PRVP Instructions, Includes QIO Language Leavitt
Announces Pilot Project to Test Initial e-Rx Standards Former AMA President Joins HealthInsight as Medical Director ACP
Recommends Reforms to Save Primary Care, Development of ‘Advanced
Medical Home’ Katrina
Phoenix Advisory Board Wins January 2006 Spirit of HIMSS Award AHCA/NCAL
Seeking Board Examiners AHIMA Sponsors
Health Information Privacy and Security Week Report Finds
QI Efforts Improve Antibiotic Prescribing The fourth
volume of the Closing the Quality Gap series released in January by
the Agency for Healthcare Research and Quality’s (AHRQ)
Evidence-based Practice Center at Stanford-USCF shows that quality improvement
interventions can reduce unnecessary prescribing of antibiotics by nearly
9% and increase appropriate prescribing by 10%. No individual quality
improvement strategy was found to be more effective than another, but “active
clinician education may be more effective than passive education.” Researchers
primarily focused on acute illnesses in the outpatient setting, particularly
acute respiratory infections (ARIs), which account for the majority
of antibiotic prescribing. They found that quality improvement interventions
targeting ARI “may exert a greater effect on overall
prescribing than interventions targeting specific types of acute respiratory
infections.” The report is available online at: http://www.ahrq.gov/downloads/pub/evidence/pdf/medigap/medigap.pdf.
Print copies can be obtained through AHRQ at 800-358-9295 or ahrqpubs@ahrq.gov.
For more information, contact Marion Torchia at mtorchia@ahrq.gov or
301-427-1399. AHQA Adopts
Standards for QIO Organizational Integrity AHQA has
publicly released its new policy, “Standards for Organizational
Integrity of AHQA Institutional Members,” calling for QIO boards
to adopt standards that will assure that all QIOs conform to the highest
standards for business practices, governance, and public accountability. The policy was approved by the AHQA Board of Directors in late December.
In a subsequent letter accompanying the new policy, David Schulke, AHQA
EVP, and Jonathan Sugarman, MD, MPH, AHQA President, asked individual
QIO boards to pledge adherence to the new standards. As of press time,
the new policy has been approved by 22 QIO boards with Medicare contracts
in 29 states. The policy
calls for QIOs to “embrace and promptly implement” new
standards of conduct regarding: board member and executive compensation;
travel expenses; conflict of interest; and structure, composition, and
independence of boards. “Most QIOs already follow these standards,” said
Dr. Sugarman, “Now we are asking that all QIOs publicly endorse
and fully comply with this policy.” Among other things, the policy asks every individual QIO board to: “Adoption of these standards by every QIO will demonstrate to
the public that QIOs are committed to fiscal integrity, and accountability
to a broad array of stakeholders. This is just the first step. We are
preparing a number of additional far reaching proposals for improving
QIO service to the public and for modernizing the work of the program,” said
Schulke. Read the full policy document at: http://www.ahqa.org/pub/uploads/AHQA_Governance_PolicyStmt_051222.pdf QIO Boards Approve New Policy Qualis Health (ID, WA) CMS Revises
PRVP Instructions, Includes QIO Language In a December 23rd, 2005 memo, the Centers for Medicare and Medicaid
Services (CMS) rescinded its November 2 statement and instructions regarding
the Physician Voluntary Reporting Program (PVRP). The effective date
of changes was January 1, 2006; implementation of this new program began
on January 3, 2006. The new policy notes that: “The
G-codes are an interim step until electronic submission of clinical
data through EHRs replaces this process. Medicare expects to work with
some physician groups that have already adopted EHRs to assist with
this transition. Medicare’s
contracted Quality Improvement Organizations (QIOs) are helping physicians
move toward a more dynamic and evolving public reporting and pay-for-performance
quality improvement environment. In specific, QIOs are providing assistance
to help physicians create systems so that the measures can be more
easily reported.” Shortly
after CMS’ announcement of PVRP in November, 2005, AHQA
met face-to-face with CMS officials Barry Straube, MD, and Bill Rollow,
MD, MPH to express concern that structuring a physician quality reporting
program on paper-based claims and G-codes would undermine physicians’ willingness
to invest in electronic health records. “The perception that future
pay-for-performance would follow the same path as the paper-based PRVP
could seriously impact QIOs’ ability to work with providers to
reach their 8th SOW goals,” said Christine Bechtel, AHQA Director
of Government Affairs. AHQA urged CMS in that meeting and in subsequent encounters to revise
existing PVRP language to clarify that the collecting of quality data
via paper claims and G-codes is a temporary measure and future collection
of quality data for reporting or payment purposes would be based on electronic
health records. AHQA also requested that CMS highlight the availability
of QIO assistance to physicians for adoption of electronic health records.
Subsequent to these efforts, significant changes were included in the
new PVRP instructions. The new
PRVP instructions are available online at: http://www.cms.hhs.gov/Transmittals/Downloads/R35DEMO.pdf.
CMS has also published a revised Medlearn Matters article (MM 4183) titled “Physician
Voluntary Reporting Program (PVRP) Using Quality G-Codes” at: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM4183.pdf.
Medlearn Matters is a series of prepared articles designed to inform
physicians, providers, and the health care community about the latest
changes to Medicare. The same language regarding use of G-codes as an
interim step is not included in this publication. “We are pleased that CMS has clarified this aspect of PVRP and
we will continue to push for consistency throughout all the agency’s
publications on this program,” said Bechtel. For more
information, contact Christine Bechtel at cbechtel@ahqa.org. Leavitt
Announces Pilot Project to Test Initial e-Rx Standards Department
of Health and Human Services Secretary Mike Leavitt announced the
launch of a pilot project to test initial standards for electronic
prescribing at the third meeting of the American Health Information
Community. The pilot project is a joint effort by the Centers for Medicare & Medicaid
Services and the Agency for Healthcare Research and Quality. The pilot
project includes four teams that have been awarded a total of nearly
$6 million for the remainder of 2006 to: These
initial standards involve transactions that will support not only
electronic prescribing itself but also will provide additional
related information to help improve quality and lower costs. For
example, the standards in the e-prescribing pilot will enable physicians
to obtain formulary information and medication history. The four
teams involved in the pilot project are: RAND Corporation, Brigham
and Women’s Hospital, SureScripts, and Achieve
Healthcare Information Technology. American
Health Information Community was convened in September 2005 by Leavitt
with the directive to advise HHS and its agencies on the implementation
of electronic health records including such issues as interoperability,
privacy, and security. Former AMA
President Joins HealthInsight as Medical Director John C.
Nelson, MD, MPH, former President of the American Medical Association
(AMA) is now Medical Director at HealthInsight, the QIO for Utah and
Nevada. As Medical Director, Dr. Nelson will share responsibility with
HealthInsight’s
leadership in promoting transformational improvements in health care
and support the teams that work with physicians, hospitals, and other
health care providers to assure that their quality improvement programs
and activities have a sound basis in clinical science. In addition
to holding leadership positions with the AMA for more than a decade,
Dr. Nelson served on the National Advisory Committee for the Agency
for Healthcare Research and Quality. He was recently appointed to the
Medicaid Advisory Commission. Dr. Nelson is also former deputy director
of Utah’s Department of Health and has served on the governor’s
task forces on child abuse and neglect and teenage pregnancy prevention.
He is former president of the Utah Medical Association and the Salt Lake
County Medical Society. ACP
Recommends Reforms to Save Primary Care, Development of ‘Advanced
Medical Home’ In a January
30 report, the American College of Physicians (ACP), the nation’s largest specialty society, suggests that primary care “is
at grave risk of collapse due to a dysfunctional financing and delivery
system,” and that without “immediate and comprehensive reforms” the
nation will see “higher costs, greater inefficiency, lower quality,
more uninsured persons, and growing patient and physician dissatisfaction.” The
report The Impending Collapse of Primary Care Medicine and Its Implications
for the State of the Nation’s Healthcare, outlines a number of
policy positions that ACP believes will rescue primary care and preserve
access to needed medical care for the nation’s aging population. At the heart of these recommendations is a call for a comprehensive
public policy initiative that would fundamentally change the way that
primary care and principal care (whether provided by primary care or
specialty care physicians) are delivered to patients by linking patients
to a personal physician in a practice that qualifies as an advanced medical
home. The ACP
defines the Advanced Medical Home as a medical practice that “acknowledges
that the best quality of care is provided not in episodic, illness-oriented,
complaint-based care—but through patient-centered, physician-guided,
cost-efficient, longitudinal care that encompasses and values both the
art and science of medicine.” ACP suggests that the Advanced Medical
Home consist of seven primary attributes: In its January
30 report calling for the rescue of primary care, the ACP also recommends
fundamental changes in third party financing, reimbursement, coding,
and coverage policies to support practices that qualify as advanced
medical homes; fundamental changes in workforce and training policies
to assure an adequate supply of physicians who are trained to deliver
care consistent with the advanced medical home model, including internists,
and family physicians; further research on the “Advanced Medical
Home” model and a revised reimbursement system to support practices
structured according to this model; and pilot testing of the Advanced
Medical Home model by Medicare and other payers “with a revised
reimbursement system that recognizes the value of physician-guided care
coordination.” For more
information on ACP’s policy recommendations and the Advanced
Medical Home, visit: http://www.acponline.org/hpp/statehc06.htm Katrina
Phoenix Advisory Board Wins January 2006 Spirit of HIMSS Award H. Stephen Lieber, President and CEO, HIMSS, presented the HIMSS Spirit
Award to the Katrina Phoenix Advisory Board (Advisory Board) during its
monthly strategic planning call. The Spirit of HIMSS Award, given to
a HIMSS member every month, recognizes those members who truly exemplify
the spirit of HIMSS through their volunteer efforts within the society.
The Advisory Board includes AHQA Director of Government Affairs, Christine
Bechtel, and the Quality Improvement Organizations (QIOs) from the states
of Louisiana, Mississippi, and Alabama, which helped identify physician
practices in need of assistance in the affected areas. Also serving on
the board are several organizations providing clinical and redesign expertise
for health information technology, such as the American Medical Association
and the American College of Physicians. Leiber noted in presenting the award that this is the first time a group,
rather than an individual, has been the Award recipient. HIMSS commended
the Advisory Board for its dedication in pressing forward to solicit
vendor donations and match to these to practices in need, along with
physician and practice redesign consulting mentoring. “With HIT adoption being a federal priority for improving the
present and future state of health care in the gulf coast region, HIMSS
in partnership with the QIOs, is a true grass roots effort. Katrina Phoenix
will not only help physicians be better prepared for any future disasters,
but it will also help substantiate the case for the EMR and improve care.
Many thanks to the Advisory Board for making the Katrina Phoenix project
a reality,” said David Collins, HIMSS, Manager, Ambulatory, Healthcare
Information Systems. AHCA/NCAL
Seeking Board Examiners The American Health Care Association and National Center for Assisted
Living are seeking Board Examiners for their annual quality award. Positions
are available for Step I, II, and III examiners. The AHCA/NCAL
Quality Award is a profession-based award program that recognizes organizational
excellence via applicant response to hybrid versions of the Malcolm
Baldrige National Quality Award criteria. “AHCA/NCAL
is particularly interested in having QIOs serve as reviewers,” said
Dave Adler, AHQA Director of Government Affairs. Members are chosen based on expertise in the quality discipline, success
in leadership of award-recipient facilities, interest in systematic quality
improvement, and other salient factors. For more information on qualifications
of Board Examiners, visit: http://www.ahca.org/quality/award_become_examiner.htm If you are interested in serving as an examiner please contact Tim Case,
Quality Award administrator, at tcase3362@charter.net, or Chris Condeelis,
AHCA Senior Director of Quality and Professional Development, at ccondeelis@ahca.org.
For more information on the awards, go to http://www.ahca.org/quality/awardinfo.htm AHIMA Sponsors Health Information Privacy and Security Week April 9 through 15, 2006, is Health Information Privacy and Security
Week, an annual event sponsored by the American Health Information Management
Association (AHIMA) to raise awareness among health care professionals,
their employers, and the public about the importance of protecting the
privacy, confidentiality, and security of personal health information. The planning kit is available online at: http://www.ahima.org/hipsweek.
A portion of the proceeds from the sale of official merchandise goes
to support the week for details: http://www.imprintmall.com/hipsweek.
Order by March 10 for guaranteed arrival of merchandise by Health Information
Privacy and Security Week. Health Information Privacy and Security Week is supported in part by
CBaySystems. Click here to
add your event to AHQA’sQuality
Calendar.
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