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AHQA Recommends Modernization of QIO Program
to CMS Nearly All QIOs Adopt AHQA’s New Governance
Policy PQA Establishes Steering Committee, Work
Groups AHRQ Partners with Business Coalitions to
Improve Diabetes Care Electronic Version of Medicare Booklet Available AHIMA Selects Nine States for RHIO Best
Practices Secretary Leavitt: Three Keys to Improve
Quality and Reduce Cost of Health Care Long Term Care Health IT Summit Planned
for June US Spends More in Health Care but Lags Behind
in Technology In a recent letter to Centers for Medicare & Medicaid Services (CMS)
Administrator Mark McClellan, MD, PhD, AHQA called for legislative and
administrative changes to modernize and ensure the accountability of
the QIO program. AHQA Executive Vice President David Schulke requested
that Administrator McClellan undertake “prompt implementation” of
administrative changes that he believes the agency can make without congressional
approval. Specifically, AHQA is asking CMS to support QIO education of beneficiaries
about their rights under Medicare’s complaint program, and to allow
QIOs to tell beneficiaries the results of complaint investigations. AHQA
is also requesting that CMS involve consumers, providers, practitioners
and purchasers—as the IOM has recommended—in the setting
of national and local priorities for the QIO program. Schulke noted that
while administrative changes could be made without involving Congress,
it would be best to also include them in federal law “to ensure
that they are a continuous priority of the program” that survives
periodic CMS leadership changes. To finance changes made prior to statutory
reforms, the letter urges CMS to use some or all of the estimated $28
million in SOW8 funds that CMS has not yet allowed QIOs to use for their
work in the field. In the letter, Schulke suggested that CMS support changes that would
finally establish quality improvement services as a core function of
the QIO program, to improve the likelihood that the Office of Management
and Budget (OMB) will fully fund that function. “In accordance
with IOM recommendations,” Schulke wrote, “the law should
clearly state, and the budget provide, that ‘QIO improvement assistance
services are available to all providers, Medicare Advantage and prescription
drug plans.’” The law should also set a formula to ensure adequate funding for the
QIO program, AHQA suggests, of no less than 0.5% of Medicare spending,
to speed the pace and expand the breadth of health care quality improvement.
Other AHQA recommendations include adoption of a mandatory competition
for QIO contracts, reform of QIO evaluation procedures, and QIO coordination
with Medicaid on quality measurement and improvement strategies. Read the letter at: http://www.ahqa.org/pub/uploads/McClellan_Ltr_QIO_Pgm_Modernization_060427.pdf Nearly all AHQA institutional members, representing 50 QIO jurisdictions,
have adopted the new policy entitled “Standards for Organizational
Integrity of AHQA Institutional Members.” The policy was approved
unanimously by AHQA’s Board of Directors on December 20, 2005 and
calls for QIOs to self-regulate at a high level of accountability in
establishing QIO executive and governing body travel, compensation, composition,
independence, and conflict avoidance and mitigation. Those adopting the
policy pledge to make organizational changes no later than December 31,
2006. “I am very grateful that such a very convincing proportion of
QIO executives and boards have responded to Association leaders’ request
that they adopt these state of the art principles in their own operations.
Now comes the hardest part, implementing them. We face skeptics in Congress
and at CMS who want to see these changes are actually being put into
effect. I hope all will immediately being demonstrating that the QIOs
are leading the way in embracing accountability for organizational integrity,” said
David Schulke, AHQA Executive Vice President. “Those who are skeptical that QIOs are serious about change are
gearing up to centralize decisions about QIO operations in Washington
, D.C. They may have the political support to do this, after the many
press stories concerning inappropriate actions by major charities and
non profits generally. Ultimately, the best rebuttal to attempts by government
officials to seize control of your internal decision-making is to show
them there is no need to do it.” The policy Cranston Appointed Executive
Director Members of the Steering Committee will guide the direction of PQA and
are appointed to three-year terms. Committee members include: Judith Cahill, Executive Director, Academy of Managed Care
Pharmacy (AMCP) Carolyn Clancy, MD, Director, Agency for Healthcare Research
and Quality (AHRQ) John Gans, PharmD, Executive Vice President and CEO, American
Pharmacists Association (APhA) Linda Golodner, President, National Consumers League Robert Hannan, Interim President and CEO, National Association
of Chain Drug Stores (NACDS) Karen Ignagni, President and CEO, America ’s Health
Insurance Plans (AHIP) Jack Mahoney, MD, Corporate Medical Director, Pitney Bowes Mark McClellan, MD, PhD, Administrator, Centers for Medicare & Medicaid
Services, (CMS) Brenda Motheral, PhD, RPh, Senior Vice President of Research & Product
Management, Express Scripts, Inc. Bruce Roberts, RPh, Executive Vice President and CEO, National
Community Pharmacists Association (NCPA) Martha Roherty, Director, National Association of State Medicaid
Directors Rebecca Snead, Executive Vice President and CEO, National
Alliance of State Pharmacy Associations (NASPA) Work groups Recommendations on the principles and methods for reporting meaningful
information to consumers, pharmacists, health insurance plans, purchasers
and other interested stakeholders is the responsibility of the workgroup
on Reporting. It will be co-chaired by Lawrence M. Brown, PharmD, PhD,
Assistant Professor of Health Science Administration, The University
of Tennessee College of Pharmacy (appointed by APhA), and William K.
Fleming, PharmD, Vice President, Pharmacy and Clinical Integration, Humana,
Inc. (appointed by AMCP). Membership in PQA is open to all interested organizations, but dues
are $25,000 per organization. Each member organization may name up to
four individuals to participate in the two workgroups. Full membership
meetings will be held twice a year. For more information, visit the PQA website at: www.PQAAlliance.org. The Agency for Healthcare Research and Quality (AHRQ) has announced
a new partnership with three of nation’s leading business coalitions
to help improve the quality of diabetes care within and across communities.
The strategies and tools developed under the new partnership, Improving
Diabetes Care in Communities Collaborative, and any lessons learned will
be disseminated broadly for communities around the nation to use in improving
the quality of diabetes care. The partnership includes the Greater Detroit Area Health Council, the
MidAtlantic Business Group on Health, and the Memphis Business Group
on Health. They will work with AHRQ to support local communities in their
efforts to reduce the rate of obesity and other risk factors that can
lead to diabetes and its complications. The partners will also work together to ensure that people with diabetes
receive appropriate health care services. Nationally, only one-half of
patients with diabetes routinely receive recommended health care services,
including eye exams, long term blood sugar (hemoglobin HbA1c) tests,
and foot exams, a rate that has not improved over the last few years,
according to data from AHRQ’s National Healthcare Quality Report
(http://www.ahrq.gov/qual/nhdr05/nhdr05.htm),
released in January. Andrew Webber, president and chief executive officer of the National
Business Coalition on Health said that wellness efforts “can have
a significant impact” on the national workforce. “Employees’ lives
are improved while employers benefit from healthier workers and realize
decreased overall medical costs and absenteeism.” Each of the coalitions has already convened stakeholders, including
businesses, providers, health plans, insurers, consumers, and academics,
to set priorities in their efforts to improve diabetes care and develop
solutions that fit within each community’s needs and capabilities.
The discussions are developing some cross-cutting strategies for addressing
diabetes quality improvement, including a return on investment calculator
for estimating financial returns from disease management, application
of the chronic care model, and an employer guide on managing diabetes
care with health plans. “All change is local,” said AHRQ Director Carolyn M. Clancy,
MD, “this is a wonderful example of how AHRQ can help communities
work together to improve and advance health care quality and the health
of their citizens.” AHRQ, in partnership with the Council of State Governments, has developed
Diabetes Care Quality Improvement: A Resource Guide for State Action
and its companion workbook, both of which are designed to help states
assess the quality of diabetes care and develop quality improvement strategies.
They can be found online at http://www.ahrq.gov/qual/diabqualoc.htm.
Printed copies may be ordered by calling 1-800-358-9295 or by sending
an E-mail to ahrqpubs@ahrq.gov. The Centers for Medicare & Medicaid Services (CMS) recently announced
the release of an electronic version of “Your Medicare Rights and
Protections,” a 44-page booklet that outlines the Medicare program
for beneficiaries. The booklet contains information for beneficiaries and their advocates
about issues like how to file a complaint or appeal and where to go to
get help with questions. It also covers basic Medicare rights, such as
the right to: The publication can be viewed online at: http://www.medicare.gov/Publications/Pubs/pdf/10112.pdf. The American Health Information Management Association’s (AHIMA)
foundation recently selected nine state-level regional health information
organization (RHIO) efforts to participate in the first phase of developing
consensus on best practices for state-level RHIOs. The nine states selected
are: California, Colorado, Florida, Indiana, Maine, Massachusetts, Rhode
Island, Tennessee, and Utah. The project, funded by the Office of the National Coordinator for Health
Information Technology (ONCHIT), will produce public domain information
on best practices in the areas of governance, structure, financing, operations,
and health information exchange policies. A steering committee of representatives from the nine state-level RHIOs
will guide the project, which includes site visits and interviews. The
steering committee, lead by Molly J. Coye, MD, MPH, founder and CEO of
the Health Technology Center, is to develop a framework for describing
and disseminating best practices and model(s) and encouraging adoption
and coordination among state-level RHIOs. A list of steering committee
members is available at: http://www.staterhio.org/team/steering.asp The National Conference of State Legislatures (NCSL), other state-level
RHIOs, and a variety of stakeholders will be actively involved in contributing
to development of the consensus best practices through an open review
process and a public consensus conference—co-convened by AHIMA’s
foundation and NCSL—planned for July 2006 in Arlington, VA. The estimated project completion date is August 31, 2006. For more
information, visit www.staterhio.org. The May 10 issue of The Hill, a newspaper widely read by Washington
policymakers, featured a special report on health care with articles
from legislators and Mike Leavitt, Secretary of the Department of Health
and Human Services. In his article, “ Transparency in Healthcare a Priority , ” Secretary
Leavitt said that there are three keys to increasing health care quality
in the US while reducing costs, “People need to know how much their
healthcare costs. They need to know the quality of the care they receive.
And they need to have a reason to care.” In addition to knowledge about the price of health care, patients also
need to know about quality, Leavitt said. “ We need the help of
organizations that define quality standards so that we can begin to assign
ratings to the quality of care patients receive. If a doctor or a hospital
is not providing good quality, two people need to know that: the patient
and the payer.” Leavitt noted that health information technology is “an essential
tool in getting this information to the public,” which is why President
Bush has made electronic health records a national priority. Read Secretary Leavitt’s article at: http://thehill.com/thehill/export/TheHill/News/Frontpage/051006/ss_leavitt.html The 2006 Long Term Care Health IT Summit: An Action, Strategy and Follow-up
Roadmap Session will be held at Baltimore’s inner harbor June 8-9
to follow-up on recommendations from the 2005 Summit. Attendees may submit
case studies for review at the Summit by May 19. The recommendations, titled 2005 Road Map for Health IT in Long
Term Care were developed by attendees of the 2005 Summit as an
outline for HIT adoption in the LTC setting for the next two years.
The Road Map, which also included action items, is the first effort
directed at HIT implementation in the LTC setting. At the second Summit, attendees will dig deeper into the 2005 Road Map
by analyzing key action items to gauge progress and identify barriers
and next steps. Topics to be discussed include: One of the Road Map’s recommendations is to advocate for special
projects through QIOs to support HIT adoption and effective use in LTC.
Read the Road Map at: http://www.ahima.org/meetings/ltc/documents/LTC_HIT_Summit_Report_Final_122005_000.pdf Meeting organizers expect more than 250 stakeholders representing consumers,
health care professionals, providers, payers, regulators, Congressional
staff, software developers, and others to attend the Summit . Attendees
will hear presentations on key issues and participate in roundtable discussions
to help develop a national agenda for HIT in LTC. Call for Case Studies Case studies may address any issue, including the Summit session topics:
Business Case/Funding, Quality Initiatives, Research and Benchmarking,
Standards, Medication Safety and E-Prescribing, Chronic Care/Wellness
Management, and Emerging Issues. Submissions are due by May
19, 2006 to michelle.dougherty@ahima.org The 2006 Long Term Care Health IT Summit: An Action, Strategy and Follow-up
Roadmap Session is sponsored by the American Health Information Management
Association, or AHIMA. Co-sponsors are: the American Health Care Association
(AHCA) and the National Center for Assisted Living (NCAL), the American
Association for Homes and Services of the Aging (AAHSA) and the Center
for Aging Services Technology (CAST), the American Medical Directors
Association (AMDA), the National Association of Home Care and Hospice
(NAHC), and the National Association for the Support of Long Term Care
(NASL). Government sponsors include: the 21st Century Congressional Health
Care Caucus, the Centers for Medicare & Medicaid Services, the Department
of Health and Human Services – ASPE, the National Institute of
Aging, and the Office of the National Coordinator for Health Information
Technology. For more information or to register, visit: http://www.ahima.org/meetings/ltc/ Although the United States spends more on health care, it lags by as
much as a dozen years in health information technology (HIT) use compared
to other industrialized nations according to findings of a new Health
Affairs study in the May/June 2006 issue. The study was s upported
by The Commonwealth Fund. The authors of the study, “Health Care Spending and Use of Information
Technology in OECD Countries,” note that in all the more-advanced
countries, “the cost of implementing an HIT program is borne by
the government or health insurers, or both.” The US could, the authors said, catch up with other nations if they
heed the lessons learned by other nations in their HIT implementation
efforts. Some of these lessons include: promoting interoperability and
adoption by providing government subsidies of HIT systems with the condition
that they interconnect; using early-adopter physicians to convert laggards;
inclusion of a wide range of health care providers, including optometrists
and dentists in the HIT system; adequately addressing privacy concerns. Read more at The Commonwealth Fund: http://www.cmwf.org/publications/publications_show.htm?doc_id=372221&#doc372221  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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