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RAM Airs on PBS, Series Continues Throughout October QIO RAM contributions
featured on MedQIC Nearly All Hospitals Voluntarily Reporting Data to
CMS Landmark Report Shows Where American Is On Health IT Adoption CMS Gears
Up for Open Enrollment—November 15 GAP-D2B: An Alliance for Quality
Seeks to Save Lives by Saving Time Congress Passes Older Americans Act,
HHS Comments AHQA Names Two New Board Members The next episode of Remaking American Medicine, “First Do No Harm,” which
begins airing October 12 focuses on efforts to prevent nosocomial infections
such as MRSA and how the use of technology can help prevent medical errors. The Remaking American Medicine series kicked off October 5 with the
first episode “Silent Killer” which highlighted an unusual
partnership between the parents of a young child who died of medical
error at the Johns Hopkins Hospital and the hospital’s staff. Working
together, they aim to eliminate the root cause of the toddler’s
death -- communications breakdowns. Preliminary results indicate that
viewership of the first segment was very high in the top 20 markets such
as Los Angeles, San Francisco, Dallas, Tampa, and Chicago. Episode two Hackensack University Medical Center in New Jersey is also featured
in episode two for its commitment to using technology as a way of reducing
medication errors. The hospital has implemented a $40 million system
that reduces errors by allowing doctors to order medications and tests
and communicate with other providers. A continuing challenge is convincing
all of the hospital’s 1400 physicians to embrace the new system. Episode three In Los Angeles, Dr. Anne Peters runs a clinic for the uninsured in East
LA where she helps patients take control of their diabetes. A team of
nurses and diabetes educators play a key role in her strategy. “If
people don’t take responsibility for their own treatment, they’re
not going to get better. I’m basically embarking on a partnership
with patients,” says Dr. Peters. Health care leaders in Whatcom County, Washington created a fully integrated
system of care to help patients with chronic diseases bridge the gaps
between multiple caregivers. One solution – hire nurses who work
on behalf of the community to help the most at risk patients manage multiple
chronic conditions. QIOs across the country are working with local coalitions in events
to support the national airing of RAM. MedQIC has developed a special
section for RAM on its website, www.medqic.org. Visitors will find details
on QIO-lead initiatives such as: The MedQIC site also provides access to QIO-developed tools and resources
such as: Lumetra’s “Viva La Vida!” to help Latinos identify
and address health care barriers. Colorado Foundation for Medical Care’s “Healthy
Impact!” to
address and improve cultural competency among providers. Portion control
and nutrition advice for diabetics from New Mexico Medical Review. Consumers can find out more information about health care quality and
the RAM series at: www.remakingamericanmedicine.org. Check local listings for viewing times at: www.pbs.org/remakingamericanmedicine. The Centers for Medicare & Medicaid Services recently announced
that 99 percent of the nation’s 3,490 acute care hospitals eligible
to participate in the agency’s voluntary reporting program reported
quality data. Under the Medicare Modernization Act of 2003 (MMA), and later revised
under the Deficit Reduction Act of 2005 (DRA), hospitals that submit
quality information to CMS are eligible to receive the full Medicare
payment update for inpatient services in 2007. Although reporting is
voluntary, those inpatient acute care hospitals that do not report will
get a two percent reduction in their annual Medicare fee schedule update,
a much greater impact than last year’s 0.4 percentage point reduction,
which was established by the MMA. For 2007, an additional 11 measures are added to the 10-measure starter
set. Heart Failure (HF): left ventricular function assessment; ACE inhibitor
(ACE-I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic
dysfunction; discharge instructions; adult smoking cessation advice/counseling Pneumonia (PNE): initial antibiotic received within four hours of hospital
arrival; oxygenation assessment; Pneumococcal vaccination status; blood
culture performed before first antibiotic received in hospital; adult
smoking cessation advice/counseling; appropriate initial antibiotic selection;
Influenza vaccination status. Surgical Care Improvement Project (SCIP) — prophylactic antibiotic
received within one hour prior to surgical incision; prophylactic antibiotics
discontinued within 24 hours after surgery end time. CMS proposes to further expand the set of measures for FY 2008 to include
additional SCIP measures, mortality measures, and patient satisfaction
using the HCAHPS Survey, also known as Hospital CAHPS or the CAHPS Hospital
Survey. Details on the proposed measures can be found on the CMS website
at: http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1185569 “This is more evidence that paying for reporting and improving
quality can help patients get better care,” said former CMS Administrator
Mark McClellan, MD, PhD. “Consumers can use this information to
evaluate care and doctors and hospitals can use it to help improve their
performance.” A first ever public/private report on the state of electronic health
records adoption was published in the October 11 issue of Health Affairs.
The study, “How Common Are Electronic Health Records in the United
States? A Summary of the Evidence,” indicates that as of 2005 almost
24 percent of physicians used an EHR but only nine percent used systems
with at least four key functionalities identified by the Institute of
Medicine such as electronic prescribing. Report author Ashish K. Jha, Harvard assistant professor of public health
and coauthors, developed national estimates of health IT adoption by
identifying and analyzing high or medium quality surveys on health IT
adoption from existing surveys on health IT adoption. Their work represents
the first report from the Health Information Technology Adoption Initiative
(www.hitadoption.org), a partnership between the federal government,
the Robert Wood Johnson Foundation, and several academic research institutions.
The initiative’s mission is to track the adoption of EHRs by both
physicians and hospitals. The literature review also found that adoption rates among solo or small
physician practices were much lower than larger practices. The authors
found data on hospital health IT use sparse, but the best available information
indicates an adoption rate of between five and 10 percent. The lack of
evidence on adoption among safety-net providers is greater but what evidence
exists shows that health IT adoption rates are even lower than other
hospitals. Jha and coauthors offer several recommendations for future measurements
of EHR adoption and use, including standardizing study methodologies
and standardizing the definition of EHR using criteria advanced by the
IOM and other organizations. They also urge greater attention to EHR
adoption by safety-net providers and others who care for underserved
populations. Given the potential of EHRs to improve quality, “ensuring
access to these tools among all providers is critical to reducing disparities
in health care,” Jha and coauthors state. “Understanding where American providers are on the adoption curve
of health IT use is critical to creating policies that promote its adoption,” said
Dr. Jha. The article by Jha and coauthors can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w496 The Centers for Medicare & Medicaid Services announced 2007 drug
plan options for beneficiaries in every state and territory and enhanced
tools to help beneficiaries make decisions about a plan during open enrollment,
which begins November 15. From November 15 through December 31, beneficiaries
who have not already signed up for the drug benefit will be able to select
a plan and those who are already enrolled in a prescription drug plan
may switch to a different plan. “If you’re satisfied with your coverage, you do not have
to do anything during the Open Enrollment period. If you are considering
a change, Medicare has new tools to help,” said former CMS Administrator
Mark McClellan MD, PhD. Eight new national organizations are offering drug plans in addition
to the nine national organizations that were available in 2006. The list
of national plans can be found at www.medicare.gov/medicarereform/local-plans-2007.asp. Beneficiaries will be able to choose from plans that offer: better benefits
or services, such as coverage in the gap and little or no deductible;
zero deductibles; and coverage through the coverage gap for as low as
$38.70. In addition to prescription drug plans, Medicare beneficiaries in 39
states will have access to the first Medical Savings Account plans and
related consumer-directed plans ever available in Medicare. These plans
provide Medicare beneficiaries with more control over their health care
utilization and health care costs, while providing them with important
coverage against catastrophic health care costs. A revised drug plan finder tool and other resources are becoming available
from CMS as the agency gears up for the 2007 open enrollment period.
The Drug Plan Finder tool has been revised and is set to launch in mid-October.
A recorded Webinar with a short tutorial that walks users through the
revised tool and highlights changes is available at: http://www.cms.hhs.gov/center/partner.asp. Drug Plan enrollment data is available at: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/02_EnrollmentData.asp Resources to help beneficiaries during the coverage gap are available
at: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/01a_bridgingthegap.asp Local plan information is available at The American College of Cardiology (ACC) is assembling and leading GAP-D2B:
Alliance for Quality, a new national campaign to reduce the door-to-balloon
(D2B) times in hospitals performing primary percutaneous coronary intervention
(PCI). The Alliance for Quality is now recruiting partners; JCAHO, Premier,
Inc., and the National Heart, Lung, and Blood Institute (NHLBI), have
already signed up. A national kick-off is planned for November 12 at
the AHA Annual Meeting in Chicago. Each year nearly 400,000 patients are admitted with ST-elevation myocardial
infarction (STEMI) and many hospitals are now treating these patients
with emergency percutaneous coronary intervention (PCI). National American
College of Cardiology (ACC)/American Heart Association (AHA) guidelines
and CMS/JCAHO performance measures state that the D2B time for these
patients should be less than 90 minutes, as clinical studies suggest
a strong association between time to primary PCI and in-hospital mortality
risk. Partners in the Alliance for Quality will develop a network of hospitals
and physician and nurse champions that will commit to improve their D2B
times. Participating hospitals will be provided key evidence-based strategies
and supporting tools needed to begin reducing their D2B times and will
have the opportunity to share their findings and experiences with others. Through GAP-D2B, all members of the hospital’s quality improvement
team will understand the importance of their role in improving door-to-balloon
times, the fundamentals of quality improvement, the evidence-based D2B
strategies, and how to implement such strategies to streamline current
processes. The content of GAP-D2B is developed by a work group including
leading experts on improving door-to-balloon times; it is chaired by
Harlan Krumholz, MD, SM, FACC. As part of GAP-D2B, participating hospitals will commit to implement
the following six evidence-based strategies: “This effort provides a great opportunity to put clinician leaders
in a position to help their hospitals to achieve extraordinary door to
balloon times. In essence, by working together, we can make what is current
extraordinary performance ordinary and ensure that all patients with
STEMI will be treated promptly with reperfusion therapy,” said
Dr. Krumholz. National kick-off Hilton Chicago There is no cost associated with attending this
meeting, but attendees will have to assume their own travel costs.
Please RSVP to Jason Byrd via email (jbyrd@acc.org) or telephone (202-375-6653)
by November 8. Those unable to attend can obtain materials via the website https://d2b.acc.org,
which is scheduled to be unveiled later this month. Michael Leavitt, Secretary of Health and Human Services and Josefina
Carbonell, Assistant Secretary for Aging U.S. Administration on Aging,
commended the Congress for the successful passage of the 16th reauthorization
of the Older Americans Act. According to these HHS officials, the act will improve the quality of
life for older Americans by providing for enhanced federal, state, and
local coordination of long-term care services; improved access to health
care services; more outreach to family caregivers; better coordination
of services to protect elders from abuse, neglect, and exploitation;
and increased opportunities for community activism. Secretary Leavitt said the Act “does much to ensure that the future
of our nation’s seniors will be one in which elders and their caregivers
are able to enjoy a higher quality of life, better health and access
to critical supportive services.” The legislation also would provide greater support for state and community
planning for the impending long-term care needs of the baby boomer generation. “The
legislation modernizes community-based long-term care systems to empower
consumers to manage their own care and make choices that will allow them
to avoid institutional care and live healthy lives in the community,” said
Assistant Secretary Carbonell. More information on the Older Americans Act is available at: http://aoa.gov/OAA2006/Main_Site/index.aspx AHQA recently announced the appointment of two new Public Directors
for its Board of Directors. François de Brantes, National Coordinator
for Bridges To Excellence (BTE) and Barbara Paul, MD, independent consultant
and national medical advisor to Community Health Systems, began serving
the AHQA board in August 2006 and may continue to serve up to six years. “As health care leaders with experience beyond the Medicare program
and independent of the QIOs, Mr. de Brantes and Dr. Paul will broaden
the insights our board can draw upon in establishing the objectives and
policies of the Association,” said AHQA president and presiding
officer of the Board of Directors, Sallie Cook, MD. Dr. Cook is also
Chief Medical Officer at the Virginia Health Quality Center, the state’s
QIO. François de Brantes Previously, Mr. de Brantes was Program Leader for health care initiatives
at GE, responsible for developing and implementing GE’s Active
Consumer strategy. Mr. de Brantes earned a Masters in Finance and Taxation
at the University of Paris IX - Dauphine, and he earned an MBA at the
Tuck School of Business Administration at Dartmouth College. “The QIOs have two critical missions to accomplish: helping physicians
improve their practice of medicine and serving the needs of a rapidly
growing population of Medicare beneficiaries by providing them with the
information they want to make good care decisions. I’m proud to
serve on AHQA’s board at this important time in the history of
the quality movement,” said de Brantes. Barbara Paul, MD Dr. Paul previously worked for the Centers for Medicare & Medicaid
Services (CMS) where she helped launch the agency’s efforts to
publicly report on quality in nursing homes, home health agencies, and
hospitals. She was instrumental in the development of Medicare’s
first “pay for quality” demonstrations and development of
the Hospital Quality Alliance. Most recently, Dr. Paul was senior vice
president and chief medical officer at Beverly Enterprises, Inc., a provider
of nursing home, hospice, and rehabilitative services to the elderly. “QIOs have an important role in quality of care for Medicare beneficiaries
and others around the country. As a board member, I look forward to helping
guide the future development and success of the organizations’ national
trade association,” remarked Dr. Paul. Dr. Paul is a board-certified Internist who previously served as chair
of the California Medical Association’s Council on Ethical Affairs
and as a member of its Board of Trustees. She is a graduate of the University
of Wisconsin - Madison, and received her MD at Stanford University School
of Medicine.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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