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Medicare Proposes Making Part D Data Available
for Research Commonwealth Reports Discuss Cultural Competency AHQA Supports Senate Measure to Eliminate Disparities QIOs Central to New P4P Demo Focusing on Small
to Medium Physician Practices AHQA and Bridges To Excellence Team-up To Recognize
Physician Practice Excellence National Governors Association to Form State
Alliance for HIE AHRQ Intends to Request Evaluation of P4Q Programs CMS Details Its Vision for Long Term Care Reform HealthGrades Study Shows Gap between High and
Low Performing Hospitals Increasing Health and Human Services Secretary Michael Leavitt and Agency for Healthcare
Research and Quality Director Carolyn Clancy, MD, joined consumer and
provider representatives at a press conference in Washington, DC to announce
a consumer-focused phase of the Surgical Care Improvement Project (SCIP).
The goal of the SCIP national partnership is to reduce by 25% the incidence
of the most common preventable surgical complications -- infection, blood
clots, and adverse cardiac and respiratory events -- by 2010. A keystone
of the consumer phase is a tip sheet designed to foster communications
between patients and caregivers. The tip sheet, “Steps to Safer Surgery,” gives patients
specific questions to ask physicians and nurses before surgery to ensure
the care provided will reduce the likelihood of complications. Questions
on the two-page tip sheet range from “If I take medicine for heart
disease, should I keep taking it?” to “If I need antibiotics
before surgery, when will I receive the antibiotic and for how long?” “Patients need to take an active role in their health care, especially
when it comes to having surgery,” said AHRQ Director Clancy. “They
need to be well informed and ask lots of questions, and the materials
developed by SCIP will help them know where to get information and what
to ask.” John Rother, AARP’s Group Executive for Policy and Strategy agreed, “Consumers
and patients need information that will help them become active partners
in their care.” Rother represented consumer groups at the press
conference along with Ilene Corina, president of PULSE and Debra Ness,
president of the National Partnership for Women & Families. “SCIP is a national quality initiative that aligns with one of
the five key strategies of the CMS Quality Roadmap: CMS must work collaboratively
with other health care partners in improving health care quality,” said
Barry Straube, MD, Chief Medical Officer and Director of the Office of
Clinical Standards and Quality at HHS’ Centers for Medicare & Medicaid
Services. “SCIP will allow consumers to be better informed and
enable health providers to make the necessary systematic improvements
that CMS and its partners feel will improve patient outcomes, while reducing
avoidable complications and costs.” CMS supports SCIP through the
QIO program’s 8 th Scope of Work contract. The consumer tip sheet, “Steps to Safer Surgery” is available
at: http://www.ofmq.com/user_uploads/FINALconsumer_tips2 An AHQA fact sheet on SCIP and QIOs is available at: http://www.ahqa.org/pub/uploads/FS_SCIP_2C.pdf The Centers for Medicare & Medicaid Services (CMS) recently issued
a proposed regulation to allow use of Medicare Part D (drug benefit)
claims data for research and quality initiatives. The agency is seeking
public input on its proposal by December 18th. Linking Medicare drug claims data to other Medicare information on patient
care such as hospitalizations and physician visit would allow researchers
and federal agencies to analyze and report on a fuller spectrum of beneficiary
care. It would allow researchers address such problems as: pinpointing
potentially serious side effects associated with the use of prescription
drugs in certain clinical circumstances, determining the potential for
cost savings of more effective adherence to drug therapies in chronic
disease management, and identifying groups of beneficiaries who are not
receiving evidence-based recommended drug therapies. CMS would also be
able to conduct demonstration projects to evaluate the impact of drug
coverage and in relation to the how Medicare drug coverage interacts
with utilization under Parts A, B, and C. “We have seen great improvements in the quality of health care
based on identifying opportunities for better care based on Medicare
information,” former CMS Administrator Mark McClellan, MD, PhD,
said. “Through the appropriate use of the new prescription
drug claims data, we have an unprecedented resource to help us learn
more about prescription drug usage by seniors and how we can help seniors
get the most benefit from prescription drugs.” The same safeguards that exist today for use of other Medicare data
with regard to the Privacy Act and HIPAA would be imposed, such as: obtaining
only the minimum data needed to complete the study; not releasing beneficiary
and provider identifiers unless absolutely necessary for the study; and
where identifiers are disclosed, ensuring strict privacy protections
are in place. The public is invited to comment on the most effective use of the data,
including whether CMS should consider additional regulatory limitations
for external researchers in order to further guard against the potential
misuse of data; to assure that priority questions are addressed as quickly
and effectively as possible; or to ensure that proprietary plan data
or confidential beneficiary data are not released. The Commonwealth Fund recently released a series of reports on the role
of cultural competency in improving health care quality and outcomes
at the fifth National Conference on Quality Health Care for Culturally
Diverse Populations. The reports include: The Role and Relationship of Cultural Competence and Patient-Centeredness
in Health Care Quality Improving Quality and Achieving Equity: The Role of Cultural
Competence in Reducing Racial and Ethnic Disparities in Health Care The Evidence Base for Cultural and Linguistic Competency in
Health Care Researchers Tawara D. Goode, MA, M. Clare Dunne,
MSW, and Suzanne M. Bronheim, PhD, investigate the impact of cultural
and linguistic competence on health care and propose barriers that
should be addressed to move forward and establish the “business
case” for implementing
such care. Cultural Competency and Quality of Care: Obtaining the Patient’s
Perspective Taking Cultural Competency from Theory to Action AHQA recently offered its support for the Minority Health Improvement
and Health Disparity Elimination Act (S. 4024), introduced by Senate
Majority Leader William Frist, MD (R-TN). The bill seeks to amend the
Public Health Service Act to improve the health and health care of populations
such as racial and ethnic minorities. Co-sponsors of the bill include
Sens. Jeff Bingaman (D-NM); Edward Kennedy (D-MA); and Barack Obama (D-IL). The bill seeks to eliminate disparities through provisions under five
major topics: education and training; care and access; research; data
analysis, collection, and quality; leadership, collaboration, and a national
plan. Among other things, S. 4024 calls for: In his letter to the Senators, AHQA EVP David Schulke characterized
the elimination of health disparities as “a central part of our
national efforts to improve both health and health care” and cited
QIO efforts to date, which have been ongoing since 1999. “Between
1999 and 2002, QIOs helped reduce health disparities in areas such as
breast cancer, immunizations and diabetes from 13.6% to 8.5%. As a result,
an estimated additional 20,841underserved Medicare beneficiaries
received better care for their condition,” he wrote. The QIO role in disparity reduction is “essential,” but
the work “accounts for only 3.4% of the QIO program budget,” Schulke
explained. “ We hope that your legislation will provide the leadership
needed to encourage the federal government to increase its commitment
to ending health care disparities. We particularly support HHS in expanding
health disparity work to be an even more important part of the QIO responsibility,” he
said. After a long delay, the Centers for Medicare & Medicaid Services
(CMS) recently announced the launch of a new three-year demonstration
project that will pay incentives to solo or small to medium physician
practices based on the quality of the care they provide to Medicare beneficiaries
with chronic conditions. The demonstration will take place in four states
-- Arkansas, California, Massachusetts, and Utah – the same pilot
states as the DOQ-IT project, as intended by its congressional authors. “We know that most patients receive care in smaller medical practices,” said
former CMS Administrator Mark McClellan, MD, PhD, “which is why
it’s so important to have an approach that works for making the
link between payment and quality of care in these settings.” Authorized under section 649 of the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (MMA), the three-year Medicare Care Management
Performance (MCMP) Demonstration will begin in 2007. To participate,
physician practices must be signed up for the DOQ-IT program and must
be the primary provider of care for at least 50 Medicare beneficiaries.
QIOs will assist in the recruitment of physician practices in each state,
for a total of approximately 2,800 physicians at 800 sites. “We are thrilled to see the launch of this unique demonstration
project that relies on QIOs,” said Christine Bechtel, Director
of Government Affairs for AHQA. “It’s the first of its kind
to test federal financial incentives in small and medium sized physician
practices that are using health IT to manage care. QIOs are playing an
important role in helping physicians succeed in a demonstration that
is designed to inform the national debate about P4P and health IT.” Participating practices will continue to receive fee-for-service payment
and will submit data annually on up to 26 quality measures related to
the care of patients with diabetes, congestive heart failure, and coronary
artery disease, as well as the provision of preventive health services
such as immunizations and cancer screenings to high risk patients with
a range of chronic diseases. Incentives will be provided just for reporting data in the first year.
This data will be used as baseline information for evaluation of each
practice’s quality in subsequent years. Beginning in year
two, practices will be eligible for an annual incentive of up to $10,000
per physician and up to $50,000 per practice based on performance on
the quality measures. The quality measures for MCMP are consistent with the measures being
used in DOQ-IT and the Medicare’s Physician Voluntary Reporting
Program and are endorsed or in the process of being endorsed by the National
Quality Forum and the AQA. Read the list of measures at: http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MMA649_Clinical.pdf The demonstration will be independently evaluated to determine its impact
on quality of care, outcomes, and cost. The HHS Secretary is required
by law to submit a report to Congress on the demonstration within one
year of its completion. CMS is also developing a value-based purchasing demonstration for nursing
homes and for home health and dialysis providers. AHQA and Bridges to Excellence (BTE) recently released a set of surveys
and other tools that QIOs can use to assess physician practices as they
re-engineer their systems of care. Physician practices determined to
meet the specific criteria will be eligible for financial rewards and
public recognition. Eligible practices will be assessed by a QIO using a common set of metrics
in the toolkit that will determine the extent to which each practice
meets certain standards related to: the adoption and use of health IT
and care management programs, active participation in clinical performance
measurement, and tracking of patients over time. Practices that achieve
a certain performance threshold will be reported to BTE as meeting criteria
of its Physician Office Link program and can become eligible to receive
financial rewards and public recognition. “Employers and health plans across the country are adopting BTE’s
programs to fuel their pay-for-performance efforts. They are looking
for physicians and physician practices that can demonstrate that they
have reengineered the way they practice medicine in a way that is consistent
with the Institute of Medicine’s six aims for better care,” said
Francois de Brantes, National Coordinator for BTE. “Physicians
and physician practices have been looking for a business case to reengineer
and our program does that. The QIOs provide an invaluable public service
by giving hands-on help to these practices and making sure that they
are delivering good quality care. This toolkit will enable all QIOs to
participate in this important effort.” “QIOs have been helping practices across the country to adopt
and use health IT and care management processes as part of their contract
with Medicare,” said David Schulke, Executive Vice President of
AHQA. “This partnership with BTE provides an opportunity to engage
practices in a new way and help them win financially, in addition to
clinically.” In August, President Bush signed an Executive Order asking all branches
of the federal government to use their purchasing power and other means
to help promote the adoption of health IT, the public release of performance
measures, and the creation of incentives to reward providers for better
performance. With the release of this toolkit, QIOs are now participating
in all four areas. Since 1999, they have been the only nationally coordinated
infrastructure helping physician practices and other providers improve
the quality and safety of their care. The toolkit is available on the AHQA website (www.ahqa.org) and www.bridgestoexcellence.org. The Office of the National Coordinator for Heath Information Technology
(ONC) recently entered a one year, $1.99 million dollar contract with
the National Governors Association’s (NGA) Center for Best Practices
to establish the State Alliance for e-Health, which will serve as a forum
where state-level consensus-based solutions can be developed to address
key challenges to interoperable health information exchange (HIE). “It is essential that the States and Federal government work in
parallel to make interoperable HIE a reality so that patients receive
high quality health care,” said Dr. Robert Kolodner, Interim National
Coordinator for Health Information Technology. “The State Alliance
will provide a unique forum in which states will be able to come together
to collectively consider HIE issues they have been struggling with and
to find solutions that will advance interoperable HIE within their communities.” Through the State Alliance, state-level decision makers such as governors,
legislators, and attorney generals, will collaborate with health information
technology experts; industry experts; and representatives of consumers,
state and Federal Governments, and other relevant organizations and associations,
to address the challenges of interoperable health information exchange
(HIE) and remove barriers to improve overall quality of health care. State-level interstate collaboration and consensus-building is needed
to resolve differences in the laws, policies, and practices that govern
potential approaches to interoperable HIE, such as: This effort will also serve to increase the efficiency and effectiveness
of the various states’ health information technology (health IT)
initiatives through the sharing of “lessons learned” from
various interoperable HIE initiatives. The Agency for Research and Healthcare Quality issued notice in the
October 24 Federal Register that it intends request permission from the
Office of Management and Budget to conduct an evaluation project on pay-for-quality
programs. The proposed project, “Evaluation of the Implementation
and Impact of Pay-for-Quality (P4Q) Programs,” would assess if
quality improves on the measures used in P4Q programs in health care
safety net settings and whether the programs lead to unintended consequences.
The project would also seek to identify best practices in P4Q programs. Information for the project would be collected through a survey of physicians
participating in P4Q programs and through interviews with up to six key
managerial staff (physicians, office managers, practice leaders, etc.)
at each target site regarding program design, implementation, and impact. Comments specifically addressing the following are requested by December
26, 2006: Increased consumer choice, patient-centeredness, transparency, and better
quality are highlights of the Centers for Medicare & Medicaid Services’ recently
released plans to reform long term care. Details of the CMS vision are
available at: http://www.cms.hhs.gov/MedicaidGenInfo/07_LTCReform.asp The CMS vision calls for a system that provides care that is patient-centered
rather than institution-centered and focuses on the following principles: By increasing consumer choice and tailoring long term care services
to individual need, beneficiaries will have greater flexibility to choose
from an array of long-term care services – such as those provided
by family caregivers, in their own homes, in communities, or in facilities.
Funding the system in a way that allows the money to follow the person
to the most appropriate and preferred setting will reduce unnecessary
costs. CMS plans to increase beneficiary quality of life by “optimizing
working conditions and job satisfaction for front-line staff.” In
addition, the agency will increase transparency to allow beneficiaries
and their families to have access to information necessary to make informed
choices and plan for the future. The recently launched “Own Your
Future” Awareness Campaign (in nine states) is an example of CMS’ efforts
to increase consumer awareness about the need to plan for long-term care
and provides tools and information to help them do so. The ninth annual HealthGrades Hospital Quality in America Study shows
that a typical Medicare patient has 69% higher chance of dying at hospitals
determined to be the lowest performing (1-star) than at the highest performing
hospitals (5-star). The “quality chasm” between the best
and poorest-performing hospitals has grown by approximately 5% since
last year’s study, even as overall mortality rates have improved
by nearly 8%. For the study HealthGrades analyzed 40.6 million Medicare hospitalization
records, from the years 2003 through 2005, to rate the quality of care
at each of the nation’s more than 5,000 nonfederal hospitals. Each
hospital gets a 1-, 3- or 5-star rating indicating poor, average or excellent
outcomes in each of 28 medical categories. Researchers analyzed such
diagnoses as: Acute Myocardial Infarction, Community Acquired Pneumonia,
Coronary Bypass Surgery, Heart Failure, and Coronary Interventional Procedures. “This year’s study finds that mortality rates among Medicare
patients continues to decline, however the differences in patient outcomes
between 5-star and 1-star hospitals remains large and is getting larger,
a concerning finding,” said Samantha Collier, MD, the author of
the study and the vice president of medical affairs at HealthGrades. The authors estimate that if all hospitals performed at the level of
a 5-star rated hospital across 18 of the procedures and diagnoses studied,
302,403 Medicare lives could have potentially been saved from 2003 through
2005. Fifty percent of the potentially preventable deaths were associated
with just four diagnoses: Heart Failure, Community Acquired Pneumonia,
Sepsis and Respiratory Failure. HealthGrades ratings are posted free on its website, www.healthgrades.com.
A copy of the study, which includes tables, is also available on the
HealthGrades website.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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