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President Bush Signs Executive Order Making
Federally-Funded Health Care Transparent to Consumers Heart Care Alliance Reaches Out to Low Performing
Hospitals CMS Announces Preventive Care Demonstration
Project CMS Alerts Beneficiaries of Payment Error
and Repayment Process Report to Congress Released on QIO Program Supports Pricing, Quality, HIT, and Efficiency Efforts President Bush recently gave a big boost to quality, transparency, and
health IT standards by signing the Executive Order, “ Promoting
Quality and Efficient Health Care in Federal Government Administered
or Sponsored Health Care Programs.” The order directs four federal
departments with health care responsibilities, the Department of Health
and Human Services, the Department of Defense, the Department of Veterans
Affairs, and the Office of Personnel Management, to: The Executive Order is one part of the President’s agenda to make
health care more affordable and accessible. In 2003, he signed legislation
to establish Health Savings Accounts; in 2004 he launched an initiative
to make electronic health records a reality within 10 years. President
Bush is also asking Congress to support Association Health Plans that
would allow small businesses or groups to jointly purchase health care
and to support medical liability reforms that would limit frivolous lawsuits
and excessive jury awards. Read the Executive Order: http://www.whitehouse.gov/news/releases/2006/08/20060822-2.html Read the Fact Sheet: http://www.whitehouse.gov/news/releases/2006/08/20060822.html Leavitt’s Comments McClellan Briefs Partners Administrator McClellan specifically noted that efforts already underway
at CMS include reporting of data on the Hospital Compare website and
the Ambulatory Care Quality Alliance (AQA) pilots designed to test data
aggregation and public reporting models. Models developed from the experience
of the six communities would likely be utilized in future performance
improvement initiatives like public reporting for physicians or pay-for-performance.
McClellan said that Medicare has been contributing data on national quality
measures and wants to see these AQA pilots expand. Currently, AQA pilots are being conducted in six states led by stakeholder
entities. QIOs in each of the six states are either already participating
in the stakeholder entity or have been discussing their potential role
with pilot leaders. In addition, the AQA and the Hospital Quality Alliance
recently formed the Quality Alliance Steering Committee, which has five
working groups; QIO leaders have been invited to serve on two of the
working groups. CMS is also trying to reduce burden on providers through efforts such
as the recent exceptions to the Stark and anti-kickback statutes, Administrator
McClellan said. The exceptions and safe harbors determine conditions
under which physicians and other providers can receive health IT software
and support from hospitals or other entities. Specifically, the new rules
allow physicians and providers to receive donated electronic health records
technology items and services from entities or hospitals to support interoperable
electronic health records and/or electronic prescribing. Recipients are
required to pay 15% of the cost of the electronic health records technology
items and services. Shows Providers Working with QIOs Improve More Providers working intensively with QIOs improve to a greater degree
than those who do not, according to an August 15 article published in
the online edition of Annals of Internal Medicine. Overall,
QIO efforts during the 7 th Scope of Work likely led to nationwide improvements
in the quality of health care provided to Medicare beneficiaries, federal
researchers. The print edition is expected to be published on September
5. In the study, “Assessment of the Medicare Quality Improvement
Organization Program,” researchers compared baseline and remeasurement
data for a total of 41 clinical quality measures (20 in nursing homes,
home health, and physician office; 21 in hospitals) from the 7 th Scope
of Work (2002-2005). For the nursing home, home health, physician office
tasks, they found that providers working intensively with QIOs achieved
greater improvement on 18 of 20 clinical quality measures than providers
that did not work intensively with a QIO. Although hospital care improved in 19 of 21 measures studied, researchers
could not compare hospitals that worked with QIOs with those who did
not because QIOs were asked to help hospital providers throughout their
state to improve. Other significant findings include: “These findings are consistent with an effect of the QIO Program
and an effect of QIO technical assistance,” wrote the authors. Noting that “this study is consistent with our experience in the
field -- providers improve faster with the QIOs’ help than when
left on their own,” David Schulke, AHQA Executive Vice President,
said that the findings underscore other recent research showing the benefit
of QIO assistance. The 2005 National Healthcare Quality Report, released by the
Agency for Healthcare Research and Quality earlier this year, found that
QIO measures for heart disease and pneumonia showed a combined rate of
improvement that was almost four times higher than all other non-QIO
measures. The American Journal of Surgery last year published
a report on a national QIO project involving 43 hospitals that reduced
their post-surgical infection rate by 27% with QIO assistance. In addition,
a CMS baseline survey (May 2006) of stakeholders working with QIOs in
health care improvement found that three out of four stakeholders said “providers
are providing better care because of QIOs.” “That assessment
by three-quarters of stakeholders is meaningful, because the natural
response is to say ‘we did this by ourselves and didn’t rely
on the QIOs much,” Schulke commented. Editorial Drs. Shortell and Peck agreed with the authors’ statement that
the findings are “consistent with an effect of the QIO program,” but
they countered that the study did not include enough evidence. “[W]e
do not know why and we cannot be sure that such improvement stemmed from
the QIO interventions,” they wrote. The editorial reiterated the IOM committee’s finding that QIOs
are a valuable resource with “enormous potential to assist in improving
the quality of health care,” but called more accurate evaluation
of the QIO program “of utmost importance.” The editorial
included IOM’s four recommendations for improved QIO evaluation, “1)
evaluating the QIO Program as a whole; 2) evaluating processes of individual
QIOs; 3) assessing the impact of selected quality improvement interventions;
and 4) assessing the QIO Program over time by using an independent external
evaluator.” It also noted that CMS has been encouraged to use a
randomized controlled design for QIO evaluation and to put together an
external panel that could provide input on the evaluation process. Hospital CEOs and administrators from the lowest performance quartile
on seven core heart care measures targeted by the Alliance for Cardiac
Excellence (ACE) are now receiving letters and information on resources
available to help them improve. AHQA and the Centers for Medicare & Medicaid
Services (CMS) are founding members of ACE. Using data (July 2004 - June 2005) from Hospital Compare, ACE identified
hospitals with lower than average scores for heart attack and heart failure
treatment. In correspondence to leaders of these hospitals, ACE explained
that its members were committed to helping them improve outcomes for
cardiac patients through established tools and resources. A list of resources is available at: www.ofmq.com/ace.html ACE includes 29 health care organizations working together to bridge
the gap between nationally accepted standards of care and the actual
care many adult cardiac patients currently receive. In June, ACE announced
its goal to ensure that 95 percent of all hospitals provide care meeting
seven core quality measures for heart attack and heart failure patients
by the end of 2006. Those seven measures include: In January 2007, ACE members will begin focusing on: smoking cessation
advice/counseling, thrombolytic agent received within 30 minutes of hospital
arrival, and PCI (percutaneous coronary intervention) received within
120 minutes of hospital arrival for AMI patients, and discharge instructions
and smoking cessation advice/counseling for HF patients. The American College of
Physicians Foundation’s Fifth Annual National Health Communication
Conference Moving Toward Real Solutions: Advances to Address
Low Health Literacy The ACP Foundation’s Fifth Annual National Health Communication
Conference, Moving Toward Real Solutions: Advances to Address Low
Health Literacy, will take place on November 29 th, 2006 , at the
National Academy of Sciences in Washington , DC . This year’s national
conference focuses on developing solutions to the problems of low health
literacy and is: With more than half of all US adults – 90 million people – having
difficulty understanding and acting on health information, the American
College of Physicians Foundation is focused on finding practical and
evidence-based solutions to the problems of low health literacy. Working
with the Institute of Medicine, the ACP Foundation is bringing together
leading researchers and stakeholders from around the country to take
a solution-oriented approach to low health literacy. This conference provides a unique opportunity for attendees from various
sectors to learn about the growing problem of low health literacy and
hear about innovative solutions that can be implemented in various locales
and settings. Speakers, selected based on topic, scope, and evidence-based
evaluations of data, include: Charles J. Ganley, MD, Director of the
Division of Over the Counter Products for the Food and Drug Administration;
Ruth M. Parker, MD, FACP, Professor of Medicine at Emory University School
of Medicine; and Jill A. Berger, MSA, Vice President, Health and Welfare
Plan Management and Design for Marriott International. See a list of
additional speakers, including biographies at: http://foundation.acponline.org/healthcom/conf06_meetspeakers.htm An agenda for this one-day conference is available at: http://foundation.acponline.org/healthcom/conf06_agenda.htm.
Online registration and other information are available at: http://foundation.acponline.org/healthcom/locationmap.htm.
Questions can be directed to foundation@acponline.org or
877-208-4189. The Centers for Medicare & Medicaid Services (CMS) has issued a
solicitation to implement a health promotion and disease prevention program
through the Medicare Senior Risk Reduction Demonstration. The program
enhances CMS’ focus on prevention of chronic disease in the Medicare
population. The program aims to determine whether health risk reduction programs
that have been developed, tested, and shown to be effective in the private
sector can be tailored to the Medicare program. “The Senior Risk
Reduction Demonstration will help us determine whether more intensive
support can help our beneficiaries stay well and prevent complications
from chronic diseases,” said Mark McClellan, MD, PhD, CMS Administrator. Eighty-two percent of seniors have one chronic condition, and about
50 percent have two or more. Seniors with these conditions have better
outcomes with fewer costly complications when they are diagnosed early,
and when they take lifestyle steps that are proven to improve their health. In addition to the demonstration project, Medicare has instituted “Welcome
to Medicare” visits for new Medicare enrollees that provide education
and counseling about important preventive services as well as screening
tests, shots, and appropriate referrals. Other preventive benefits Medicare
offers include: cardiovascular screening blood tests, diabetes screening,
counseling to quit smoking, and glaucoma screening for Hispanic Americans. CMS will select up to five existing health promotion, disease prevention,
and risk reduction organizations to participate in this three-year demonstration.
Final award decisions should be made by spring 2007. For more information: http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/Senior_Risk_Reduction_Solicitation.pdf Senate Finance Committee Leaders Vow Action The Centers for Medicare & Medicaid Services (CMS) recently sent
letters to about 230,000 beneficiaries who erroneously received a refund
of Part D premiums; beneficiaries are being asked to repay or return
the money to CMS. Beneficiaries’ prescription drug coverage has
not been impacted by this error. As a result of a Medicare processing error, the beneficiaries received
a separate extra payment in their social security checks that refunded
the Medicare drug plan premiums withheld to date by CMS. The extra payment
amounts average $215 but most beneficiaries received less than $200. The letter asks Medicare beneficiaries who may have received more money
in their social security payment than anticipated to set the extra money
aside so that it can be returned to Medicare. Initial correspondence
did not include payback instructions, but CMS has since released information
on how beneficiaries can do so. Beneficiaries who received a refund check and have not cashed it can
mark “VOID” on the check and return it to: Medicare—Drug
Premiums, PO Box 9058 , Pleasanton , CA 94566-9058 . Those who wish to
repay the money by personal check or money order can do so by sending
either to the same address. Beneficiaries who are not sure if they were affected or wish to discuss
options for repayment, including monthly installments, can call 1-866-292-8080
between 7 AM and 9 PM Eastern time to speak with a Medicare representative.
Beneficiaries with additional questions can call 1-800-MEDICARE. Medicare will re-start withholding premium payments from Social Security
checks on October 1. Partner information is available at: http://www.cms.hhs.gov/center/partner.asp Senate Finance Committee “Medicare beneficiaries need to be able to count on the drug
benefit program, not only for prescription drugs, but also for accurate
administration that doesn ' t cause financial hardship,” said Baucus. “I
want to know whether this is a one-time mistake, or whether there are
structural problems around withholding premiums that might lead to this
issue again.” A date for the meeting has not been determined but both Senators said
it would be soon after Congress reconvenes in September. Recommendations Reflect House Bill Secretary of Health and
Human Services Michael O. Leavitt released a report to Congress outlining
his response to a March 9, 2006 study from the Institute of Medicine,
which called for maximizing the potential of the Quality Improvement
Organization (QIO) program. Many of the Secretary’s recommendations
are aligned with legislation (HR 5866) introduced in July 24, 2006 by Representative
Michael Burgess (R-TX), which aims to strengthen the QIO program. The Secretary’s report to Congress characterized the QIO program
as “a cornerstone [of CMS] efforts to improve quality and efficiency
of care for Medicare beneficiaries,” saying that “The Program
has been instrumental in advancing national efforts to measure and improve
quality, and it presents unique opportunities to support improvements
in care in the future.” “We applaud the Secretary and CMS for this thoughtful and comprehensive
response to the IOM report,” said David Schulke, AHQA Executive
Vice President. “The release of this report signals that the time
has come for formal consideration of the important policies proposed
by Secretary Leavitt, the Institute of Medicine, Members of Congress
and other national stakeholders. We look forward to working with Congress
and with CMS to strengthen the program for the future.” The newest evidence of QIO value is laid out in the Annals of Internal
Medicine article “ Assessment
of the Medicare Quality Improvement Organization Program,” an
analysis of QIOs’ 7 th Scope of Work results. The article was
published online August 15, 2006, and will appear in the print edition
on September 5. It s howed that providers who worked most closely with
QIOs from 2002-2005 improved their care more than those who did not. “This
study demonstrates that the QIO program is more than capable of improving
the quality of Medicare services and making a difference in patients’ lives,
and strongly suggests that patient care is better for the work of these
organizations,” said Schulke. Leavitt’s report to Congress proposes important changes that are
also reflected in HR 5866, such as increasing the ability of QIOs to
be transparent and accountable to consumers, expanding outreach to educate
beneficiaries about their right to make formal complaints about poor
quality care and improving the evaluation of the QIO program. Other recommendations
supported by AHQA include: The report to Congress also addresses governance issues, but in a way
that goes far beyond requirements of other federal contractors, including
those under Medicare. The report acknowledges that “any requirements
related to contractor governance boards can create barriers to competition,” yet
its appendix proposes to regulate details such as maximum board size
and tenure. “Early this year, QIOs voluntarily agreed to adopt
and implement the ‘Standards for Organizational Integrity of AHQA
Institutional Members,’ a new code of conduct that sets high standards
for board and executive compensation, diversity, travel expenses, and
conflict of interest. QIOs responsible for 50 of the 53 QIO contracts
agreed to implement the new code by the end of this year. We believe
it would be much more effective for CMS to audit contractor compliance
with existing industry standards of organizational integrity, which are
drawn from extensive study of best practices in non-profit governance,” said
Schulke. The Secretary’s report is available at: www.cms.hhs.gov/qualityimprovementorgs/ Annals of Internal Medicine article: http://www.annals.org/cgi/content/full/0000605-200609050-00134v1  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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