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Quality Update for July 27, 2006 Bill to Modernize and Strengthen QIO Program Introduced in House IOM Report on Medication Errors Calls for Vast Changes, Increased Communication and Coordination CMS to Provide State Grants to Improve Quality and Efficiency of Medicaid AQA and HQA Join Forces for Better Coordination CMS Testing Transfer of Medicare Data to PHRs Heat-Related Illness Fact Sheet Offered by AOA On July 24 Representative Michael Burgess, MD (R-TX) introduced legislation in the U.S. House of Representatives that would strengthen and modernize the QIO program and reform physician payment. AHQA promptly announced its strong support for the bill, HR 5866. In a press release, the American Medical Association (AMA) said that Dr. Burgess “took an important step toward replacing the flawed Medicare physician payment formula,” and quoted AMA Board Chair Cecil B. Wilson, MD as saying, “This bill is a major step toward ensuring health care access for seniors.” The American College of Obstetricians and Gynecologists informed Dr. Burgess of their “strong endorsement” of the legislation. Important Links: Read AHQA’s press release [pdf] Fact Sheet on QIO Provisions of HR 5866 [pdf] Statement of AHQA President, Sallie Cook, MD [pdf] Read Rep. Burgess’ press release The following links are available on the Burgess press release: HR 5866, the Medicare Physician Payment Reform and Quality Improvement Act of 2006, includes three titles – Title I lays out Rep. Burgess’ plans to reform the physician payment structure under Medicare, Title II would modernize the QIO program, and Title III proposes savings to offset the costs associated with implementing Title I. “Every portion of this bill is to improve Medicare for patients and providers,” said Congressman Burgess. Cosponsors of the bill include: Rep. Dan Burton (R-IN); Rep. John R. “Randy” Kuhl, Jr. (R-NY); Charles Norwood (R-GA), Dave Weldon, MD (R-FL); Charles Boustany, Jr. (R-LA) and Phil Gingrey, MD (R-GA). Title II — QIO Program Modernization “AHQA’s Government Affairs team has worked for many months to pull together legislation to accomplish broad reforms of the QIO program, while taking into consideration IOM’s recent recommendations and the needs and views of the QIOs themselves. I think they have done a superb job of crafting this legislation and working with QIOs and Representative Burgess’ office to place these reforms on a legislative vehicle that would get some prompt attention from congressional leaders.” “As the saying goes, ‘all politics is local’ – and the QIO community owes a great deal of thanks to Dr. Bill Gamel, CEO of the TMF Health Quality Institute, for his leadership and willingness to reach out to Dr. Burgess, his former colleague and compatriot in the Texas Medical Association, for support of the QIO provisions.” The legislation codifies most of the major reforms proposed by AHQA earlier this year to make the Medicare beneficiary complaint process more responsive to consumers, and ensure diversity and consumer representation on QIO governing bodies. Among other things, the Burgess bill will: Schulke noted that most of the governing statute for the QIO program was written more than twenty years ago. “We’ve learned a lot about our health care system during that time, and we know a lot more now about how to effectively promote reliably high quality care,” he said. “Congressman Burgess’ bill recognizes that modernizing the QIO program is crucial to improving health care quality across the country,” said AHQA President Sallie Cook, MD. Physician Payment Reform — Title I “Medicare cannot continue to provide seniors’ with high quality health care while slashing reimbursements to the physicians who care for them,” stated AMA Board Chair Dr. Wilson. “The increasing costs of providing care coupled with a decline in reimbursement rates also make it difficult for physicians to invest in new health care technologies that can be used to improve quality.” “Attaching the QIO provisions to a physician payment reform measure makes sense for two reasons,” said Schulke. “First, Congress must address physician payment before the end of the year to avoid an estimated 4.6% cut in reimbursement that will take effect January 1, 2007. Second, it conceptually links payment to quality and increases the likelihood that QIOs are part of the solution – making them able to help physicians take the necessary steps to improve care.” AHQA Vice President of Government Affairs, Todd Ketch, also noted that the bill is also an ideal vehicle for QIO program modernization because, “To put it bluntly, it’s going to move,” he said. “Enactment of this legislation will empower QIOs to provide all health professionals with the tools and model practices they need to improve the quality of care,” continued Schulke. “We are very grateful to Dr. Burgess for his leadership and we urge Congress to adopt this legislation, so that all Americans can benefit from safer, more effective, and more efficient care.” The Institute of Medicine recently released its latest report in the Quality Chasm series, Preventing Medication Errors. The report estimates that each year at least 1.5 million people are harmed by medication errors at a cost of about $3.5 billion annually and calls on all facets of the health care system to implement changes. In the report, the IOM recommended a series of actions for patients, health care organizations, government agencies, and pharmaceutical companies. Committee members focused on patient involvement and improved communications throughout the entire chain of care during a press conference announcing the results. They said patients are a critical component to improving the system and should be more engaged in health care. Committee member Albert W. Wu, MD Professor of Health Policy and Management and Internal Medicine at Johns Hopkins University told the audience, “As a patient you have crucial information that your health care team needs in order to do a good job…it’s your obligation to volunteer that info.” Echoing sentiments of other committee members, Dr. Wu admitted that, as a practitioner, he was “shocked at how serious and common a problem this is,” and that everyone needs to wake up to take part in the solution. Other recommendations for improvement include: In a press release, the Centers for Medicare & Medicaid Services, which supervised the report required by section 107 of the Medicare Modernization Act (MMA), said that the IOM recommendations underscore the important role government can play in providing resources to address the problems IOM noted. CMS outlined current efforts that are already in place to address some of the issues raised by the IOM, such as “working with local Quality Improvement Organizations to use medication reconciliation and focus on the reliability of transfers and handoffs from one care setting to another.” QIOs are also helping providers adopt health IT systems that will ultimately support e-prescribing. Senator Charles Grassley (R-IA), Chairman of the Senate Finance Committee said in a statement that “Of particular interest to me as the chair of the Finance Committee, which has jurisdiction over Medicare, is the Institute of Medicine’s assertion that almost nothing is known about the benefits and risks of medications for people over age 80 and those taking medications for multiple conditions.” The IOM also recommended increasing research funds to beef up scientific evidence related to medication use. Senator Grassley noted that the IOM call for increased research is “consistent with the provisions contained in the “Fair Access to Clinical Trials Act of 2005” or “FACT Act” (S. 470) which I co-sponsored with Sen. Dodd.” The FACT Act aims to foster transparency and accountability in health research and secures public access to basic information about clinical trials. Co-chair J. Lyle Bootman, dean and professor, College of Pharmacy, University of Arizona, Tucson, explained, “Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems.” Pre-pub copies of the report are available at: http://www.nap.edu/catalog/11623.html Mark McClellan, Administrator of the Centers for Medicare & Medicaid Services (CMS), recently announced that CMS would provide $150 million in 2-year grants to states to fund transformation of the Medicaid system by conducting research and design of ways to increase the quality and efficiency of care. “The availability of these grant funds dovetails nicely with the policy we have put forward in our proposed legislation,” said David Schulke, AHQA Executive Vice President. Title II of the Medicare Physician Payment Reform and Quality Improvement Act of 2006 (HR 5866), which was introduced this week by Representative Michael Burgess (R-TX), includes provisions that allow states to contract with QIOs for quality improvement activities. Section 207 of the bill clarifies that states can draw 75% enhanced federal matching dollars for quality improvement work they hire QIOs to do. “As state-based organizations expert in addressing issues related to health care system improvement, QIOs are uniquely qualified to conduct this work,” Schulke noted, adding, “Some QIOs may already be doing this work in their states, and those states may have qualified for the enhanced match. Our objective in Section 207 of the Burgess bill is to substantially increase the degree of alignment of Medicare and Medicaid quality oversight and improvement.” Drawing upon expertise developed in the course of their work for Medicare beneficiaries, QIOs are poised to address many of the priority areas CMS identified for these new Medicaid grants, including: Funds for the Medicaid grants were authorized by the Deficit Reduction Act of 2005 (DRA) and are aimed at state adoption of innovative systems to get more value out of the money they spend providing health care to low-income elderly, children, and people with disabilities. While the DRA set aside $75 million for each of 2007 and 2008, grants will be given for both years at one time. All states will be eligible for a grant and amounts will vary depending on the number of states that apply. No state matching funds are required. Letters announcing the grants were sent to state Medicaid directors on July 25th. CMS will hold a teleconference to discuss the grants on August 15. Due date of the grant applications is September 15 and awards will be announced in October. More information is available at: http://www.cms.hhs.gov/MedicaidTransGrants/ Two key health care quality alliances, the AQA alliance and the Hospital Quality Alliance (HQA) announced the formation of a new national Quality Alliance Steering Committee to better coordinate the promotion of quality measurement, transparency, and improvement in care. “This new steering committee will help coordinate efforts across a broad spectrum of cross-cutting issues as the two organizations continue working toward a more uniform approach to measuring and reporting hospital and physician performance nationwide,” said Dr. Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ) director. Working closely with the Centers for Medicare & Medicaid Services and AHRQ (key members of both AQA and HQA) the committee will consider how best to expand the scope, speed, and adoption of the work of AQA and HQA. As a first step, the steering committee will coordinate and expand several ongoing pilot projects that are designed to combine public and private information to measure and report on performance in a way that is fully transparent and meaningful to all stakeholders. The new joint steering committee includes: Janet Corrigan, National Quality Forum; Robert Dickler, Association of American Medical Colleges; Karen Ignagni, America’s Health Insurance Plans; Chip Kahn, Federation of American Hospitals; Peter Lee, Pacific Business Group on Health; Debra Ness, National Partnership for Women & Families; Nancy Nielsen, American Medical Association; Margaret O’Kane, National Committee for Quality Assurance; Jeff Rich, Society of Thoracic Surgeons; Gerry Shea, AFL- CIO; John Tooker, American College of Physicians; and Rich Umbdenstock, American Hospital Association. The AQA alliance is a diverse national coalition of more than 135 organizations that seeks to improve health care quality through a process in which key stakeholders agree on a strategy for measuring, reporting, and improving performance at the physician level. The Hospital Quality Alliance (HQA) is a public-private collaboration to improve the quality of care provided by the nation’s hospitals by measuring and publicly reporting on that care. CMS recently awarded two contracts totaling $500,000 to test the transfer of Medicare claims data into Personal Health Records (PHRs). The six month contracts were awarded to ViPS and Capstone Government Solutions. The goals of the project are to: Currently, Medicare beneficiaries can use the My.Medicare.gov internet portal to access personalized Medicare claims information, due dates for preventive services, enrollment information (including prescription drug plans), online forms, publications, and Medicare messages as well as other insurer information. As this internet portal expands and the functionality of PHRs grows, beneficiaries will enjoy greater access to health information that will better equip them to manage their health care. “By using emerging technologies and tools, people with Medicare will be better able to manage their health care, resulting in improved quality in the care they receive and ensuring that care is provided more efficiently,” said CMS Administrator Mark B. McClellan, MD, PhD. A fact sheet on caring for older Americans during times of excessive heat was recently developed by the Administration on Aging. “How to Lower the Risk of Heat-Related Illnesses,” contains symptoms of heat-related illnesses and tips on prevention. It also includes resources for assistance with energy bills and more detailed information on specific heat-related illnesses. Some materials are available in Spanish. For a copy of the fact sheet visit:  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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