Quality Update for March 31, 2006

AHRQ Launches New Tool Providing State-Level Quality Data; QIOs Urged to Promote State Data QIOs across the Country Plan Activities to Support RAM CMS Selects Sites for Minority Cancer Care Demo CMS Changes Name of National Article Series for Providers GAO Report Finds HHS on Track in Health IT Strategy Hospital Survey to Measure QI Efforts Poll Shows How Americans Feel about Assessing, Paying for Health Care Quality Hospital Compare Driving Change in Hospital QI AHRQ Launches New Tool Providing State-Level Quality Data; QIOs Urged to Promote State Data At a recent national conference for health care reporters in Houston, Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, MD, announced a new interactive Web-based tool that provides each state a way to evaluate its health care quality. The new State Snapshot tool breaks down data from the 2005 National Healthcare Quality Report (NHQR) and the 2005 National Healthcare Disparities Report (NHDR), released earlier this year, into state-specific snapshots. “It is important for states and other health care policymakers to know how their state is doing in providing care,” said Clancy, noting that The State Snapshot tool provides a multitude of valuable information, including: State ranking tables that rank the 50 states and the District of Columbia on 15 representative measures of health care quality culled from 179 measures contained in the 2005 NHQR. Summary measures of the quality of types of care (prevention, acute, chronic) and settings of care (hospital, ambulatory, nursing home, and home health) for each state. Comparisons of each state’s summary measures to regional and national performance relative to the region or nation. Performance meters that show at a glance a state’s performance relative to the region or nation. Data tables for each state’s summary measures that show the NHQR detailed measures and numbers behind the performance meters. Also, the State Snapshot tool features a special focus on each state’s performance in the treatment of diabetes across three areas: Quality of diabetes care. Disparities in diabetes treatment. Cost savings that states might accrue by implementing disease management for diabetes for state government employees. This tool presents a new opportunity for QIOs to promote awareness of the need to improve health care quality, said AHQA EVP David Schulke, “Improvements are needed at all levels and in all settings -- and QIOs are the only force in every state helping providers get there. We all need to talk more publicly about what we are doing to speed the pace of change.” AHRQ will partner with four states in 2006 to develop a complementary guide to the State Snapshot tool that will help states use the information from the tool for priority setting and quality improvement. To view the State Snapshot tool, go to http://www.qualitytools.ahrq.gov/qualityreport/2005/state. Back to top QIOs across the Country Plan Activities to Support RAM QIOs have been working for more than a year with coalitions in their states on individualized efforts to support the upcoming RAM series, set to be aired in September 2006. Focusing on health care priorities in each state, coalitions have been formed to address topics ranging from preventive care to chronic illness, or public education about health care delivery and quality. Nationwide, there are 31 local RAM coalitions – all involving QIOs. Nine coalitions are led by QIOs; the other 22 are led by PBS stations with various levels of QIO involvement. RAM coalitions have enlisted the support of 390 local organizations, a number that is expected to grow as grassroots campaigns expand. Some examples of recent efforts include: Beginning in early 2006, Louisiana Public Broadcasting (LPB) worked with coalition members, including Louisiana Health Care Review, to make available information about patients’ rights and important reports about providers located throughout the state. LPB is also conducting a series of town meetings with consumers and providers throughout the state in February and March. In February, WETA of Arlington, Virginia and the American Heart Association sponsored a RAM booth at the African-American Health Fair for women in Washington, D.C. Delmarva is participating in this coalition. In an effort to gain additional local support for the WHUT coalition in Washington, DC, Delmarva Foundation’s Regional Health Initiative committee heard a RAM presentation on upcoming campaign activities in January. In addition, the station sponsored a booth at the NBC-4 Health Expo and distributed RAM promotional material to more than 500 visitors. Many coalition activities involve production of local PBS programs about important health care issues in their states. While some of these programs have already aired or will shortly, as is the case with Remaking Missouri Medicine, a collaborative effort between Primaris, the state’s QIO, and a local PBS station, most will also be broadcast on local PBS stations during September – to give local perspective to the national RAM documentary. For instance, Alabama Quality Assurance Foundation is wrapping up work with its local PBS station on a broadcast production while WEDU in Tampa, Florida plans to rebroadcast Diabetes and You with a phone bank of volunteers to answer question during September -- a successful program it developed with FMQAI, which was originally broadcast last year. Last fall, The Carolinas Center for Medical Excellence completed its documentary “Transforming North Carolina Healthcare,” which was also shown at this year’s AHQA Annual Meeting in Miami. Additional highlights from coalition efforts include: WCVE/WHTJ in Richmond, Virginia is focusing on care for the underserved. The station is working with the Virginia Health Quality Center to produce a Health Care Passport, a pocket-sized guide to medical tests and other items that patients can use when discussing their health care needs with physicians and other providers. Colorado Foundation for Medical Care collaborated with Rocky Mountain PBS to produce a CD-ROM entitled A Guide for Colorado Physicians: Cultural Competency that encourages physicians to take statewide cultural competency training. CIMRO of Nebraska is writing a story about RAM and Nebraska outreach efforts for Physician Reviewer Quarterly. The state’s RAM coalition is also using CIMRO’s website as its organizing tool. • In South Carolina, SCETV is working with Carolinas Center for Medical Excellence and others to focus on improving chronic care – particularly in older adults. Upcoming activities include a town hall event featuring local Champions of Change who will discuss how to deal with chronic illnesses. For more information on RAM coalition activities or QIO involvement, contact Richard Deutsch at rdeutsch@ahqa.org. Back to top CMS Selects Sites for Minority Cancer Care Demo The Centers for Medicare & Medicaid Services (CMS) recently announced the selection of six sites for a four year demonstration project to improve the early detection and treatment of breast, cervical, colorectal, and prostate cancers in minority Medicare beneficiaries. By incorporating the patient navigator model, the demonstration project will allow more than 13,000 minority Medicare beneficiaries to better “navigate” the health care system and receive care in a more timely and informative manner. The services each site will provide will help participants overcome barriers to three components of cancer care—screening, diagnosis, and treatment. Project sites will help participants schedule timely appointments for cancer screening and, if needed, follow-up diagnostic testing. The sites may also provide assistance with treatment adherence, transportation, translation or interpretation, and care coordination. The six sites and the five minority groups they serve include: American Indian: Huntsman Cancer Institute at 3 tribal locations in north central Montana and 11 tribal locations throughout Utah Asian American and Pacific Islanders: Molokai General Hospital in Molokai, Hawaii Hispanic - Mexican American: University of Texas in Harris County and Houston, Texas Hispanic - Puerto Rican: New Jersey Medical School in Newark, New Jersey African American: Johns Hopkins University in Baltimore, Maryland African American: Josephine Ford Cancer Center in Oakland, Macomb, and Wayne Counties, Michigan “Reducing disparities in cancer screening, diagnosis, and treatment is essential to improving quality of care for people with Medicare, and this demonstration will allow us to determine the effectiveness of the navigator model to achieve this,” said CMS Administrator Mark McClellan. Back to top CMS Changes Name of National Article Series for Providers The Centers for Medicare & Medicaid Services (CMS) has changed the name of its “Medlearn Matters” article series to “MLN Matters.” CMS states that the change is “to more closely associate these articles with the Medicare Learning Network, the official educational information source for Medicare Fee-for-Service providers.” (http://www.cms.hhs.gov/MLNGenInfo/) The series consists of national articles designed to inform physicians, providers, and suppliers of health care services about the latest changes to the Medicare program. In addition to the name change, MLN Matters articles have a new logo and a new URL on the CMS website. To view MLN Matters articles, visit: http://www.cms.hhs.gov/MLNMattersArticles/ For information about the name change read MLN Matters article SE0620 at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0620.pdf PVPR Changes Explained in MLN Matters Article CMS has changed several performance measure CPT codes and added select CPT Category II codes to the Physician Voluntary Reporting Program (PVRP). Changes will be effective April 1, 2006. Details are available on pages 5-7 of the MLN Matters article MM5036, available at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5036.pdf Additional information about PVRP is available at http://www.cms.hhs.gov/PVRP. Back to top GAO Report Finds HHS on Track in Health IT Strategy In a recent report to the House Committee on Government Reform, the Government Accountability Office (GAO) found that the Department of Health and Human Services (HHS) has “continued to develop a national health IT strategy.” Following President Bush’s call for adoption of Health IT within 10 years, the GAO recommended that HHS set up a detailed plan of action to meet the national goal. One year later, GAO was asked to assess the progress being made by HHS to develop a national health IT strategy and provide an overview of the integration of federal agencies’ health IT initiatives related to the national health IT strategy. The report highlighted recent actions by HHS including: Establishing the organizational structure of the Office of the National Coordinator for Health IT (ONCHIT) Awarding $42 million in contracts through the ONCHIT to support health IT development. Establishing the American Health Information Community, a public/private group to help lead interoperability and electronic health records. Collaboration with other federal agencies, Departments of Veterans Affairs, Defense, and Commerce, the Office of Personnel Management, and the National Institute for Standards and Technology Read the full report at: http://www.gao.gov/new.items/d06346t.pdf Back to top Hospital Survey to Measure QI Efforts Boston University’s Health Policy Institute and the American Hospital Association’s (AHA) Health Research and Educational Trust affiliate have teamed up to survey hospitals on the extent of their quality improvement activities. With funding from the Commonwealth Fund, Boston University and AHA will survey hospitals with the intent of identifying existing quality improvement activities with the most potential and areas where future efforts might be needed. Survey participants will be provided with overall study findings as well as those for their own hospitals, enabling comparisons to their peers. Hospital CEOs have been contacted about the project. Those with questions should contact Deborah Bohr at dbohr@aha.org or 646-678-4280. Back to top Poll Shows How Americans Feel about Assessing, Paying for Health Care Quality Respondents in an online poll by The Wall Street Journal and Harris Interactive said that although they agree health insurance plans should pay higher fees to those who provide better quality care, the majority said it would be unfair for patients to pay “a significantly higher premium” for better quality care. About one-third of respondents were not sure how to measure quality. The poll, conducted by Harris Interactive, included a nationwide cross section of 2,123 adults. Nearly half (49%) of the respondents said there are fair and reliable ways to “measure and compare the quality of care provided by different hospitals and different medical groups.” One third (35%) said they were not sure. When asked which indicators of care would be fair or unfair for “health plans to measure and compare the quality of care provided by medical groups” respondents said: Patient satisfaction surveys: 69% fair vs. 9% unfair. Clinical measures of chronic care management: 61% fair vs. 11% unfair Assessments by medical boards: 58% fair vs. 13% unfair. Assessments by third party organizations (JCAHO, NCQA): 57% fair vs. 11% unfair. Frequency of preventive screening tests: 55% fair vs. 17% unfair. Use of EMR and other information tools: 47% fair vs. 21% unfair Malpractice suits: 41% fair vs. 27% unfair. With the exception of patient satisfaction surveys, nearly one third of all respondents were “not sure” whether an indicator of care would be fair. Back to top Hospital Compare Driving Change in Hospital QI In a March 2006 Issue Brief, Mathematica Policy Research, Inc. published the results of its assessment of CMS’s Hospital Quality Initiative, including a national telephone survey of hospital administrative leaders, such as chief executive officers, quality improvement (QI) directors, and chief medical officers, on internal impacts of Hospital Compare. More than a quarter of those hospitals that showed a significant decline in a measure said the decline was due to documentation problems or bad outlier cases. For those hospitals showing substantial room for improvement on one or more measures, survey responses revealed three main barriers to improving their scores: Inaccurate documentation: cited as a barrier by 90% of responses from both quality improvement directors and senior executives. Failure to involve physicians: reported by 76 percent of senior executives and 83 percent of quality improvement directors Insufficient resources: between 70 and 76 percent of survey respondents cited a general lack of financial resources. “Public reporting can also induce providers to make changes to improve their quality of care even ahead of consumer demand, in response to concerns about reputation or legal exposure,” the Issue Brief said. Despite the obstacles, the public reporting of Hospital Compare is driving hospitals to make changes. Within the last two years, the survey found: An increase in hospital manpower dedicated to reporting quality data. About 60% of hospitals purchased new computer hardware or software to support quality measurement and reporting. Nearly all quality improvement directors (95%) said their hospital implemented new or enhanced quality improvement initiatives. More than three-quarters (85%) said their hospital had undertaken new data collection or abstraction activities for quality measurement purposes. Read the Issue Brief at: http://www.mathematica-mpr.com/publications/PDFs/hospcompare.pdf Back to top

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