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Massachusetts Legislates Health Care for All, Creates Quality and
Cost Council AHQA Submits Testimony on HIT to House Subcommittee AHQF/eHI HIE Report
Released to Public BtE and eHI Form Business Relationship to Share Resources
and Advance Quality CMS Announces Significant Progress in Fistula First AHRQ Report Shows
Small Practices Need Assistance for HIT Adoption Group Releases Common
Framework for HIE Maryland Develops End-of-Life Guide for Health Care
Proxy Spanish Kidney Disease Materials Available Massachusetts Legislates Health Care for All, Creates Quality and
Cost Council Massachusetts Governor Mitt Romney recently signed into law a bill that
will make health insurance available to every state resident by 2009.
The new law also includes the creation of a quality and cost council
and collection and publication of data, which will allow consumers to
compare the quality, track record, and cost of hospitals and providers. Under the new law, every Massachusetts resident will be required, by
July 1, 2007, to purchase health insurance. For uninsured individuals
not eligible for Medicaid, those with lower incomes will receive premium
assistance on an income-based sliding scale for policies with no deductibles;
those with higher incomes will be able to purchase lower-cost policies
in the private market. Premium assistance will be financed by redirecting
a portion of the $1 billion currently spent by state government on the
uninsured. Beginning on January 1, 2008, failure by individuals to purchase health
insurance will result in the loss of their state tax refund equal to
50 percent of an affordable health insurance premium. Penalties will
be assessed for each month without creditable coverage. The creation of an entity, the Commonwealth Care Health Insurance Connector,
will allow individuals to purchase affordable plans on a pre-tax basis,
will administer premium assistance for low-income individuals, and will
facilitate employer contributions for both full-time and part-time workers
and those working at more than one company. Non-working individuals, working individuals at companies that do not
offer health insurance, workers not eligible for coverage at their place
of business such as part-timers, contractors, and new employees, small
businesses with 50 or fewer employees, and those who are self-employed
will be able to use the Connector. In comments delivered at the bill’s signing, Governor Romney said
that the bill can lead to: “every citizen with affordable, comprehensive
health insurance; small businesses able to conveniently buy insurance
for their employees at a cost that’s competitive with big businesses;
medical transparency, bringing marketplace dynamics to health care, really
for the first time; and finally beginning to rein in health inflation.” Quality and Cost Council “We at MassPRO applaud the work of the legislature to provide
access and insurance to some of the most vulnerable citizens in our Commonwealth.
Specifically, we are very excited to play a lead role in working with
the executive office of health and human services to promote high quality
health care through the implementation of the quality and cost council,” said
Jane McCarthy MS, RN, Senior Director, External Relations at MassPRO. “Both the coverage enhancements and little noticed quality improvement
provisions of this legislation should serve as a model to QIOs and their
allies in improving the quality of care through state initiatives,” said
AHQA Executive Vice President, David Schulke. Read the new law at: http://www.mass.gov/legis/laws/seslaw06/sl060058.htm In addition to improving access to health care financing, the legislation
contains several provisions designed to improve health care quality,
including: AHQA Submits Testimony on HIT to House Subcommittee In testimony submitted to the House Committee on Ways and Means, Subcommittee
on Health, AHQA Executive Vice President David Schulke told lawmakers
that QIO assistance in helping providers adopt health information technology
(HIT) is “already proving to be highly valued by physicians in
the field,” noting that in just eight months, nearly 3,000 practices
have signed up for assistance from their local QIO. Schulke told Members of Congress that QIOs will ultimately work with
a total of 4,000 primary care practices during the 8th Scope of Work
and four out of five will be small to medium sized practices, which are
most likely to need QIO assistance with HIT adoption. The models for QIO assistance with HIT adoption were developed through
the four-state DOQ-IT project completed by QIOs in California (Lumetra),
Utah (HealthInsight), Arkansas (Arkansas Foundation for Medical Care),
and Massachusetts (MassPRO), just prior to implementation of the 8th
Scope of Work. All QIOs across the country are now using these models
to help providers under their 8th Scope of Work contract, Schulke said. In addition to developing these valuable tools, the DOQ-IT pilot showed
that “Physicians need help from independent organizations that
can be there for them throughout the process of adoption, implementation
and effective use of HIT. They need support from systems change experts
who can help ensure that care processes are redesigned to reflect best
practices,” Schulke testified. “Literature and experience” he continued, show that “as
many as half of all EHR implementations fail for one reason or another,
often because practices did not go through the rigorous preparation and
development necessary for success.” Having QIO assistance, Schulke
told lawmakers, helps providers overcome these barriers and successfully
use EHRs to improve patient care and prepare for upcoming pay-for-performance
P4P initiatives. “Using HIT to report data, measure quality, and
undertake improvement will give participating physicians a major leg
up” on P4P said Schulke. Read the testimony at: http://www.ahqa.org/pub/uploads/AHQA_Testimony_HIT_WM_ AHQF/eHI HIE Report Released to Public AHQA recently released the final report, Quality Improvement Organizations
and Health Information Exchange, to the public. Prepared by the American
Health Quality Foundation, AHQA’s educational arm, with assistance
from the eHealth Initiative, the report was given to congressional staff
in March. Report authors found that QIOs are accelerating the formation of health
information exchange (HIE) nationwide. More than 40 QIOs are currently
supporting local, regional, and statewide initiatives to develop health
information exchange (HIE) networks. QIOs are also convening stakeholders
and helping communities reach consensus on the goals, operation, and
funding of HIE initiatives. QIOs bring a “quality improvement focus
to the building of an HIE” in addition to the important role as
a neutral convener, said Deirdre Gifford, MD, MPH, Director, Outpatient
Quality Improvement at Quality Partners of Rhode Island at the March
briefing for congressional staff. “The benefits of establishing viable HIE are obvious,” said
Christine Bechtel, AHQA Director of Government Affairs, “But how
to do it is not. Communities face enormous challenges securing upfront
funding, creating a sustainable business model, and helping health providers
adopt HIT to connect with each other. QIOs are in the forefront of helping
their communities make progress in these areas.” Other findings from the report include: Results of a recent eHealth Initiative (eHI) survey of more than 100
state, regional, and community-based initiatives showed that HIE development
is on the rise nationwide. “Given the similar interests, goals
and objectives of QIO and HIE initiatives,” authors of the AHQF-eHI
report noted, “we expect QIOs to work even more closely with these
initiatives in the future, expanding their roles over time.” The report is available online at www.ahqa.org. RHIO Wiki BtE and eHI Form Business Relationship to Share Resources and Advance
Quality Bridges to Excellence (BtE) and the eHealth Initiative (eHI) recently
announced a new business agreement that will allow each to maintain separate
legal identities and boards of directors but share management support
to enhance administrative efficiency. The new business relationship is
expected to enable each organization to leverage a broader set of tools
and resources to promote quality improvement. eHI will inform and educate
the states, regions, and communities with which it works of the role
that BtE plays to improve quality of care and BtE will become part of
eHI’s portfolio of tools. For the most part, the members, partners, and customers of both eHI
and BtE will see few changes in their interactions with each organization.
The mission, goals, objectives, and plans of each organization will remain
intact. BtE will continue to be run by co-founder Francois de Brantes,
who has stepped down from leading health initiatives at General Electric;
eHI will continue to be led by its current CEO, Janet Marchibroda. “This relationship makes sense because both organizations are
working to transform health care throughout the United States,” says
John Glaser, president of eHI and chief information officer for Partners
HealthCare System in Boston. “eHI is driving transformation by
engaging multiple stakeholders at the state and local levels to mobilize
health information electronically. BtE is driving transformation by engaging
healthcare purchasers and health plans to develop and deploy rewards
to physicians for higher quality healthcare and wider use of information
technology,” he says. Under a model developed by MassPRO, practices participating in DOQ-IT
can be eligible for BtE financial rewards if BtE is active in the state.
AHQA is working with several QIOs and the Blue Cross Blue Shield Association
to expand BtE activity to more states and, with MassPRO and BtE is working
to develop tools to help QIOs in this process. Back
to top The Centers for Medicare & Medicaid Services (CMS) recently reported
significant progress in improving care for patients with kidney disease,
exceeding the Nation’s Healthy People 2010 goal for vascular access
for kidney disease 5 years ahead of schedule. The fistula adoption rate
has increased to 41 percent from a baseline of 33 percent in 2003. The
coalition’s goal is a 66 percent fistula adoption rate by 2009. Fistula First is a “National Vascular Access Improvement Initiative” that
aims to provide safer, higher-quality access to hemodialysis for patients
who suffer from End Stage Renal Disease (ESRD). Patients who receive
dialysis with an access method other than a fistula have a 20 to 70 percent
greater chance of death in the first year after their placement. In addition,
fistulas cost less to place and maintain than other forms of access and
are associated with less rework and complications requiring hospitalization. “The Fistula First initiative is an excellent example of how real
improvements can be made in our health care system by working with providers
to change processes, impart knowledge and increase education on state
of the art techniques,” said Barry Straube, MD, who serves as acting
CMS Chief Medical Officer and is a nephrologist. This progress noted so far, CMS said in a press release, is largely
due to the work of the national Fistula First Breakthrough Coalition,
a group of kidney disease stakeholders that is working to improve and
extend lives for thousands of people living with chronic kidney disease.
Qualis Health, the QIO for Washington and Idaho, and Louisiana Health
Care Review, the ESRD Networks, and CMS are among others listed as coalition
members on the Fistula First website. For more information on Fistula First: www.fistulafirst.org AHRQ Report Shows Small Practices Need Assistance for HIT Adoption In a report, the Agency for Healthcare Research and Quality (AHRQ) found
that while health information technology (HIT) has been shown to improve
quality of care for patients, most health care providers need more information
about how to implement these technologies successfully. The report, “Costs
and Benefits of Health Information Technology,” is a synthesis
of recent HIT studies prepared by the Southern California Evidence-based
Practice Center-RAND Corporation, one of 13 evidence-based practice centers
supported by AHRQ. The authors conclude that scientific reviews have shown significant
improvements in the quality of health care utilizing HIT systems. However,
these successes have occurred primarily within large health care systems
that devoted substantial resources to HIT adoption. “More widespread
implementation of HIT is limited by the lack of generalizable knowledge
about what types of HIT and methods for its implementation will prove
most useful for specific health organizations, especially for small practices
and small hospitals,” the report said. “Smaller practices and hospitals need to know how these improvements
can be achieved in settings like theirs, using the kinds of commercial
systems they are likely to employ. AHRQ’s health IT initiative
is designed to generate and share the kind of information providers need,” said
AHRQ Director Carolyn M. Clancy, MD. AHRQ’s HIT initiative provides
grant funds for more than 100 projects across the country where HIT systems
are being implemented. Findings from these projects will be available
through the AHRQ National Resource Center for Health Information Technology,
at http://www.healthit.ahrq.gov. The report also offered recommendations for future research, including: QIOs, through the 8th Scope of Work, are working with at least five
percent of adult primary care practice sites in every state to help them
adopt and use HIT effectively -- most of them small to medium sized. The report is available at http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf Group
Releases Common Framework for HIE Connecting for Health, a public-private collaborative of more than 100
organizations, recently released its Common Framework: Resources
for Implementing Private and Secure Health Information Exchange. The Common
Framework provides 16 initial elements of a comprehensive approach for
secure, authorized, and private health information sharing, so that patients
and their authorized providers can have access to vital clinical data
when and where they need it. The Common Framework includes technical and policy components developed
by experts in information technology, health privacy law, and policy.
The policy components determine how information is protected; the technical
components determine how information is exchanged. “We believe
it was critical that these technology and policy resources be designed
in tandem. Together, they protect patient privacy while enabling the
authorized exchange of medical records,” said Carol Diamond, MD,
MPH, managing director of the Markle Foundation. Together, they include: One of the key functions of the Common Framework is to enable a diverse
group of existing and developing networks to have a common way to share
health information – the basis of health information exchange initiatives. “The
policy components of the Common Framework can save time and effort on
the part of many organizations and networks working on health information
exchange,” said John Halamka, MD, CEO of MA-SHARE and emergency
physician, Beth Israel Deaconess Medical Center, Boston, Mass. “We know from a recent report that 42 QIOs are significantly involved
in local HIE initiatives, many in leadership roles. For those QIOs, the
Common Framework should save time and resources by providing both technical
architecture and model policies and procedures,” said Christine
Bechtel, AHQA Director of Government Affairs. AHQA EVP David Schulke
serves on the Connecting for Health Steering Committee, where Bechtel
serves as AHQA’s primary representative. In addition to AHQA, the Connecting for Health initiative includes more
than 100 collaborators, such as: the Markle Foundation, the Robert Wood
Johnson Foundation, American College of Physicians, the Centers for Medicare & Medicaid
Services, the Leapfrog Group, and Blue Cross Blue Shield. The Common Framework is available for free at: http://www.connectingforhealth.org/commonframework/index.html Maryland Develops End-of-Life Guide for Health Care Proxy Maryland recently became the first state to release an end-of-life guide
and handbook designed to educate family members or friends about serving
as a health care proxy. Created in collaboration with the American Bar
Association, “Making Medical Decisions for Someone Else: A Guide
for Marylanders,” could serve as a national model in addressing
end-of-life medical issues. Maryland Attorney General J. Joseph Curran Jr. is considered a national
leader in end-of-life care policy. Curran has encouraged Maryland citizens
to use advanced directives, plans that enable people to let their preferences
for medical care known in the event they cannot speak for themselves.
The new guide and handbook goes a step farther by giving family members
and friends designated to serve as health care proxy key information
on how to fulfill that role, which allows them to make medical decisions
for someone else. These resources will be particularly helpful in situations
where no advanced directive exists – as was the case with Florida
resident Terri Schiavo. Spanish Kidney Disease Materials Available The National Kidney Disease Education Program (NKDEP) recently developed
a Spanish-language brochure and website (www.nkdep.nih.gov/espanol) with
consumer information on kidney disease. Developed in collaboration with medical experts and Hispanic community
organizations, the resources provide science-based information on the
risk factors for kidney disease, the basic principles of kidney function,
and the importance of early testing. The materials also stress the availability
of medications that can prevent or slow the progression of kidney disease.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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