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Report Shows Consumers Want Health Care
Quality Data Most MEDIC Issues Fraud Alert for $299.00 Part
D Scam AHRQ/DOD Release Toolkit to Improve Teamwork,
Communication in All Health Care Settings Proposed Regulation Requires Sprinkler Systems
in All Nursing Homes AHRQ Launches Tools to Help Primary Care
Clinicians Select Preventive Services Studies Show Improving Processes of Care
Could Reduce Nosocomial Infections and Save Money Experts Offer Grant Advice to Community,
Rural Hospitals in FREE Audioconference AoA Awards $1.2 Million for Senior Medicare
Patrol Integration Projects Toolkit Helps Boost Vaccination, Outbreaks
in LTC Study: P4P Often Part of HMO Payment Structure AHRQ Tip Sheet Aims to Help Hospitals Improve
Patient Safety AHRQ Funds Medical Simulation Projects Designed
to Improve Patient Safety Brief Outlines National Health Care Disparities
Problems Registration Update! Early bird registration
has been extended! Discounted registration rates for the 2007 AHQA Annual
Meeting, to be held February 13-15, at the New Orleans Marriott in New
Orleans, Louisiana, will be available until Friday, December 22, 2006.
For registration information and questions, contact Amanda Scott at ascott@ahqa.org or
202-331-5790 ext. 1567. Strategic Partners Assist AHQA in getting the Word Out! AHQA 2007 Annual Meeting Strategic Partners Become a Strategic Partner Each partner organization
will be recognized during the 2007 AHQA Annual Meeting as a valued partner
and leader in the continuing effort to improve health care quality. Opportunities
remain for local stakeholder organizations, membership associations,
business coalitions, and even QIOs to become strategic partners of the
2007 AHQA Annual Meeting. For information, contact Jacqueline Osborne
at josborne@ahqa.org or 202-331-5790
ext. 1575. Exhibitor Space Still Available! 2007 Annual Meeting Exhibitors All exhibitors receive: Visit the AHQA website http://www.ahqa.org/pub/inside/158_1107_5550.cfm for
more information or contact Jacqueline Osborne at josborne@ahqa.org or
202-331-5790 ext. 1575. Hotel Reminder: Hotel r eservations at the
New Orleans Marriott will only be accepted via the AHQA registration
process through Monday, January 8, 2007 . Sleeping rooms are assigned
as each participant or exhibitor registers for the conference. Participants
will not be allowed to make hotel reservations directly with the New
Orleans Marriott. Hotel confirmations will be sent to participants
by AHQA. Each room reservation must be confirmed and guaranteed with
a valid credit card on the AHQA registration form - http://www.ahqa.org/pub/inside/158_1107_5520.cfm A Blue Cross and Blue Shield Association (BCBSA) report shows that
consumers seek quality information more than cost information when making
key health care decisions. The report “Consumer Preference and Usage of Healthcare Information” includes
Internet survey responses from more than 1,600 individuals with both
Blue Cross and non-Blue cross insurance. Eighty-six percent of
those surveyed searched for quality information compared to 47 percent
who searched for cost of treatment information. Quality information
also ranks highest in importance when selecting a hospital or clinic
with 77 percent of consumers ranking quality as a factor over cost (53
percent). Despite these findings, “A large unmet need exists among consumers
for quality information (e.g., patient satisfaction, clinical indicators,
third-party evaluations), especially on physicians,” the authors
wrote. They found that nearly half of those surveyed sought but
could not find quality information on physicians. Other areas where
consumers had trouble finding quality information include: patient satisfaction
ratings, third party evaluations, and clinical indicators on complications
and mortality. The report also noted that presentation of the data is critical – providing
clinical quality data in conjunction with cost data allows consumers
to make better decisions on care. Without this correlation, consumers
generally equate cost of care with quality of care. Other findings include: “Transparency in health care information is a growing trend and
consumers want increased access to information so they can make the best
decisions regarding their health care options,” said Scott P. Serota,
BCBSA president and CEO. The research study is available for download at http://www.bcbs.com/consumertransparency. Health Integrity, LLC, the CMS Medicare Drug Integrity Contractor (MEDIC),
recently issued a National Medicare Fraud Alert for a $299.00 scam regarding
the Medicare Part D prescription drug plan. Health Integrity, a subsidiary
of Delmarva Foundation, the QIO for Maryland and the District of Columbia,
is contracted by CMS to monitor complaints and initiate fraud investigations
for referral to the Office of Inspector General. According to the Alert, individuals and entities claiming to be representatives
of Medicare-sponsored prescription drug plans are contacting beneficiaries
and offering to enroll them in a Medicare Part D plan. Beneficiaries
are asked for personal and bank account information in order to enroll.
Typically, callers require initial “payments” of $299.00
or similar amounts to be withdrawn from the beneficiary’s bank
account. Some callers have had prior access to the beneficiary’s
personal data such as Medicare or Social Security numbers. Reports of similar scams involving individuals identifying themselves
as employees of the Social Security Administration (SSA) have also been
received. In these instances, which primarily affect beneficiaries in
Wisconsin, the callers indicate that SSA is sending out replacement Social
Security and Medicare cards and they need to verify a beneficiary’s
personal and/or direct deposit banking information. The Inspectors General at SSA and the Department of Health and Human
Services, as well as the Federal Trade Commission, are investigating
these scams. Beneficiaries and others with information about these scams
should contact Health Integrity at 1-877-7 SAFERX or any regional office
of the Office of Inspector General, U.S. Department of Health and Human
Services. The Agency for Healthcare Research and Quality (AHRQ) and the Department
of Defense’s military health system recently released TeamSTEPPS,
a jointly-developed toolkit designed to prevent medical errors by improving
communications and teamwork in health care settings, particularly high-stress
situations such as hospital emergency departments, critical care units,
operating rooms, and obstetrical suites. The evidence-based toolkit includes more than 20 years’ research
on team performance in both military and civilian settings and has been
field-tested extensively. “Patient safety is a national priority
and one of AHRQ’s most important commitments,” said AHRQ
Director Carolyn M. Clancy, MD. “Our goal is to share this important
new tool with every health care facility in America to help them create—and
continue—team training systems.” The multimedia toolkit includes materials to help a health care organization
plan, conduct, and evaluate its own team training program. The curriculum
can be tailored to any health care setting where communication and teamwork
are important, including physicians’ offices and ambulatory clinics.
Components include: “AHRQ and the Department of Defense have joined forces to bring
a much-needed product into the public domain. We want to see TeamSTEPPS
used in both military and community health settings,” added David
Tornberg, MD, Assistant Secretary of Defense for Health Affairs. A video of the TeamSTEPPS tools can be viewed on the Uniformed Services
University of the Health Sciences website: http://www.usuhs.mil/cerps/teamstepps.html.
Single copies of the CD-ROM and DVD, the poster, and the pocket guide
can be obtained free of charge from the AHRQ Publications Clearinghouse
by calling 800-358-9295, sending an E-mail to AHRQPubs@ahrq.hhs.gov,
or using the ordering form on the AHRQ Web site at http://www.ahrq.gov/qual/teamstepps. A limited number of assembled toolkits, including the CD, DVD, and printed
materials in a 3-inch loose-leaf binder, are also available for purchase
from the AHRQ Publications Clearinghouse, on a single-copy basis. A new regulation proposed by the Centers for Medicare & Medicaid
Services would require that nursing homes serving Medicare and Medicaid
beneficiaries install automatic sprinkler systems throughout their facilities.
CMS requests public and industry input on an appropriate phase-in time;
comments are due by December 26, 2006. CMS already requires newly constructed nursing homes and those undergoing
major renovation to have sprinkler systems. The proposed rule addresses
only the older homes that are not currently required to have such systems. In a July 2004 report, the Government Accountability Office determined
that the lack of smoke alarms in nursing homes in Hartford and Nashville
may have contributed to delayed response time and fatalities in fires
that occurred in 2003. Following that report, CMS increased by 17-fold
the number of life safety code (LSC) inspections performed at nursing
homes between 2004 and 2005. The LSC is a set of fire protection requirements
that covers construction, protection, and operational features designed
to provide safety from fire, smoke, and panic. CMS plans to publish the number of LSC violations, as well as information
on smoke alarms and sprinkler systems for every nursing home in the country
on its Nursing Home Compare Web site by the end of this year. “Automatic sprinkler systems are integral to increasing safety
in nursing homes, and we look forward to their installation in all of
the nursing homes across the country,” said Leslie V. Norwalk,
acting administrator of CMS. The proposed rule was published in the October 27 Federal Register: http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-17911.pdf A new Electronic Preventive Services Selector (ePSS) tool for primary
care clinicians to use when recommending preventive services for their
patients was launched at the National Prevention Summit in Washington,
DC. The interactive tool is an aid to clinical decision-making at the
point of care with a ‘real time’ search function that allows
a clinician to input a patient’s age, gender, and selected behavioral
risk factors, such as whether or not they smoke, in the appropriate fields.
The tool cross-references that data with the applicable U.S. Preventive
Services Task Force recommendations and generates a report specifically
tailored for that patient. (The Task Force is an independent panel of
private-sector experts in prevention and primary care that conducts rigorous,
impartial assessments of the scientific evidence for the effectiveness.
Its recommendations are considered the gold standard for clinical preventive
services.) The ePSS can be downloaded for use on a personal digital assistant (PDA),
which works with Palm and Windows operating systems. The desktop computer
version allows clinicians to print out individualized health reports
that can be shared with their patients. “I am proud of this product,” said AHRQ Director Carolyn
M. Clancy, MD. “The ePSS can provide a basis for initiating important
and sometimes difficult conversations between patients and their health
care providers.” The tool can be viewed and is available for download from the AHRQ Web
site at http://www.ePSS.ahrq.gov. AHRQ is also partnering with United Health Foundation to distribute
more than 400,000 free copies of the 2006 Guide to Preventive Services
to clinicians across the country. The guide contains 53 new or revised
recommendations from the Task Force. Free copies are available at: http://www.ahrq.gov/clinic/pocketgd.htm. Three new studies published in a November 20 supplement to the November/December
issue of the American Journal of Medical Quality estimate the
costs of nosocomial infections and find that they result from processes
within the hospital rather than from the variations in the underlying
medical conditions of patients at admission. “The work of these three study groups spotlights the reality that
providers have control over the processes of care that can greatly reduce
or eliminate the human and financial costs of hospital acquired infections,” said
David Schulke, American Health Quality Association Executive Vice President.
He added, “There are also important lessons here about the limited
power of financial incentives to improve quality. These hospitals could
have controlled the processes of care, and they were suffering financially
from their failure to control those processes, but still they did not
effectively manage their operations. Often, money is neither necessary
nor sufficient to solve quality problems. What matters most is for caregivers
and administrators to make the commitment to learn how to improve, and
to ask for help if they need it.” Through their 8 th Scope of Work
contract QIOs are helping hospitals implement process changes that reduce
surgical complications, including infections. In “Economics of Central Line-Associated Blood Stream Infections,” lead
author Richard Shannon, MD, and others from Allegheny General Hospital
in Pennsylvania analyzed hospital costs and revenue for care provided
to 54 patients with central line-associated bloodstream infections (CLABs).
They found that the hospital lost an average of $26,839 per CLAB case – or
more than $1.4 million for all 54 cases. “ Moreover, the argument
that certain classes of infections, such as CLABs and ventilator-associated
pneumonia, may be present on admission and not hospital acquired is unsubstantiated
by our data and seems unlikely given that central line and ventilator
use are generally hospital based,” they said. “Our study suggests that the price of central line infections
is considerable and that neither patients, payers, nor hospitals benefit,” wrote
the study team. Significant economic opportunity exists in the reduction
or elimination of CLAB infections. The authors suggest that the analysis,
which was confined to cases in one state, be replicated “on a national
scale to confirm the true magnitude of the economic opportunity.” Michael Peng, MPH, PhD and others found that the severity of a patient’s
disease condition at admission does not account for higher mortality
rates and longer length of stay in patients with hospital-acquired infections.
For their study, “Adverse Outcomes From Hospital-Acquired Infection
in Pennsylvania Cannot Be Attributed to Increased Risk on Admission,” the
researchers used unique patient identifiers to match hospital infection
data from the Pennsylvania Health Care Cost Containment Council (PHC4)
to patient records in a large multi-institutional database. After adjusting
for severity of disease at admission (and higher mortality risk), those
patients with hospital acquired infections still displayed a significantly
higher rate of mortality than patients without hospital acquired infections.
No statistically significant differences in the findings were seen by
hospital bed size or teaching vs. non-teaching status. “ Reducing
factors that contribute to the development of HAI can save lives, decrease
costs, and save valuable health care resources,” the authors concluded. Christopher Hollenbeak, PhD, and colleagues studied the risk of infection
for three common types of surgical procedures: circulatory, neurological,
and orthopedic in “Factors Associated with Risk of Surgical Wound
Infections.” Consistent with other research findings, patient factors
such as diabetes, age, and obesity contributed to the development of
surgical infections. However, “much of the risk of surgical wound
infections is determined by hospital factors,” the authors concluded.
Hospital factors include process elements such as hand washing and level
of traffic through the operating room. “ Hospital infection control
policies and procedures focus on systematic process improvements that
will shift the curve to decrease risk for infections. Such process improvements
should be independent of patient-specific factors,” wrote the authors. In an accompanying editorial, “Hospital-Acquired Infections: Raising
the Anchoring Heuristic” David Nash, MD, MBA, lamented that many
in the health care industry believe that hospital acquired infections
are “simply a risk of doing business.” These three studies,
he suggests, “will do much to help us prove the fallacy of the
anchoring heuristic that infections do occur and cannot be prevented.” The
studies also make “it clear that it is the process of care, not
the underlying clinical condition of the patient, that drives the current
epidemic of HAI,” continued Dr. Nash. “ I sincerely hope
we will make the necessary commitment to more deeply evaluate the contribution
of processes of care to HAI and take action to change those processes
for the better.” The supplement is available at: http://ajm.sagepub.com/content/vol21/6_suppl/ The Centers for Medicare & Medicaid Services (CMS) recently announced
changes in payment that will support improved quality reporting in home
health agencies and improved physician-patient communication in two final
rules. Home Health Quality Reporting The final rule also changes how Medicare will pay for oxygen and oxygen
equipment, as well as capped rental items, such as wheelchairs and hospital
beds, and establishes new protections for beneficiaries who require these
items. “This rule rewards home health agencies who continue to report
quality data and also provides beneficiaries with access to more affordable
oxygen equipment,” said Leslie V. Norwalk, Esq., Acting Administrator
of the Centers for Medicare & Medicaid Services. The payment updates are provided for in Section 5201(c) of the
Deficit Reduction Act (DRA) of 2005 . The final rule is available at: www.cms.hhs.gov/HomeHealthPPS/downloads/CMS1304Fdisplay.pdf . Improved Physician-Patient Communication “The rule we are announcing today will pay physicians more for
the time they spend talking with their patients about their health care,” said
CMS Acting Administrator Norwalk in a November 1 press release. “We
believe that this emphasis on personalized care will lead to better outcomes
for patients, and more efficient use of health care resources.” Payment for the face-to-face visits during which the physician and
patient discuss the patient’s health status and the steps that
can be taken to maintain or improve the patient’s health will be
increased significantly. Medicare will also expand its preventive services
benefits to include payment for ultrasound screening for abdominal aortic
aneurysms in at risk beneficiaries and expand the availability of a number
of services, including: “CMS believes that paying more for screening services to detect
and treat health problems early will improve the quality of life for
Medicare beneficiaries while saving money for both the beneficiaries
and taxpayers,” said Ms. Norwalk. PVRP Measures CMS projects that it will pay approximately $61.5 billion to over 900,000
physicians and other health care professionals in 2007 as a result of
the payment rates and policies adopted in this rule. On Friday, December 15, 2006 , at 1 PM Eastern HealthLeaders Media
and industry expertswill present a live audioconference
about obtaining grants to update technology in community and rural hospitals.
The FREE event is underwritten by McKesson. Hosted by Carrie Vaughan, editor of the HealthLeaders Media Community
and Rural Hospital Weekly http://www.healthleadersmedia.com/crhlc/index.cfm,
the 90-minute program will offer senior leaders at community and rural
hospitals tips on securing grants to fund health IT projects in their
facilities. Expert speakers will provide guidance on how to: manage the grant application process, budget the necessary resources,
identify potential partners, implement strategies to identify funding
priorities, and matching organizational goals to grant funding types.
They will also provide tips on key elements agencies seek and tools to
help get the process underway. Featured speakers include: Register for this FREE event at: http://healthleadersmedia.com/url/1177 Assistant Secretary for Aging Josefina G. Carbonell recently awarded
nearly $1.2 million to fund 15 new Senior Medicare Patrol (SMP) Integration
projects, which are designed to train retired professional volunteers
to help educate older Americans, their families, and caregivers to identify
fraud, abuse, and billing errors in the Medicare benefit. According to Jolie Crowder, Vice President of Special Projects at American
Health Quality Foundation and Director of the SMP National Resource Center
, “A good portion of the grants are focused on developing materials
and methods to reach out to a variety of historically underserved populations-
for example, nursing home residents and non English speaking populations. These
populations are particularly vulnerable to errors, fraud and abuse because
of their reliance on a smaller subset of health care providers that speak
their language.” Ms. Crowder also explained that nursing
home or home health patients can be particularly vulnerable because they
may be fearful of reporting problems and often do not have the ability
to switch providers when a problem arises. SMPs have a strong track record of performance said Ms. Crowder. Outcomes
data reported from the HHS Office of the Inspector General (OIG) documented
total savings of $291,389 in the last six months of 2005 and more than
$104 million since 1997 from the program’s efforts. Other
findings from the 2005 OIG report: Identifying Fraud in Part D By the end of this year, the SMP program is expected to take action
to establish a common identity and brand for the program. In addition,
a new online program management tool to streamline the tracking and reporting
of complaints by SMPs to various entities—including MEDICs, MACs,
QIOs and local law enforcement is planned for launch this fall. For more information on the SMP program, visit www.smpresource.org. The American Medical Directors Association (AMDA) recently released
a toolkit to help medical directors and other practitioners boost vaccination
compliance among both residents and staff in long term care facilities
and improve the processes for managing influenza outbreaks in LTC facilities.
AMDA is the national organization of medical directors who work in nursing
homes. The kit, which is in a customizable CD-Rom format, presents an overview
of the federal regulations, discusses barriers to immunization and strategies
to overcome those barriers, employee immunization programs, role of the
medical director, developing facility policy, managing shortages and
outbreaks, among other things. “The American Association of Homes and Services of the Aging,
American College of Health Care Administrators, American Geriatrics Society,
American Health Care Association, Assisted Living Federation of America,
American Society of Consultant Pharmacists Immunization Action Coalition,
National Association of Directors of Nursing Administration/LTC, National
Association of Health Care Assistants, National Citizens’ Coalition
for Nursing Home Reform and the National Conference of Geriatric Nurse
Practitioners are all coming together in this goal to improve immunization
efforts in both residents and staff,” said Naushira Pandya, MD,
CMD, Chair of AMDA’s clinical practice committee. To order the Immunizations in the Long Term Care Setting Toolkit
and DVD, visit www.amda.com or call
410/740-9743. A November 2 New England Journal of Medicine study shows that
more than half of the nation’s health maintenance organizations
(HMOs) used pay-for-performance programs in their contracts with doctors
and hospitals in 2005. The research was supported by the Agency for Healthcare
Research and Quality (AHRQ). Nearly 90% of the HMOs that used P4P included the arrangements as part
of their physician compensation and more than one-third included them
in their hospital contracts. The authors found that P4P arrangements
are more often associated with HMOs that use primary care physicians
as gatekeepers to specialty care, use “capitation” arrangements
that give primary care doctors set payments each month based on the number
of patients they have in a given health plan, or are themselves rewarded
by performance-based incentives. Nearly all health plans with physician programs included measures of
clinical quality (100 percent of capitated plans; 79 percent of non-capitated
plans). Use of information technology and patient satisfaction measures
were relatively common elements of physician incentive programs, the
study found. “This study is the first to assess the prevalence of pay-for-performance
programs among HMOs and describe how they are used among physicians and
hospitals,” said AHRQ Director Carolyn M. Clancy, MD. “The
findings are exceedingly valuable and come at a time when the federal
government is beginning to develop a value-based hospital payment system
for Medicare enrollees,” she said. Full text of the article is available at: http://content.nejm.org/cgi/content/full/355/18/1895 An editorial by Elliot Fisher, MD, MPH, on P4P programs is also available
in this issue: http://content.nejm.org/cgi/content/full/355/18/1845 Practical tips for promoting a culture of patient safety, limiting shifts
for medical residents and interns, and adopting interventions to reduce
cases of ventilator-associated pneumonia and catheter-related urinary
tract infections are among the evidence-based research findings that
HHS’ Agency for Healthcare Research and Quality has compiled to
help hospitals provide the highest quality care possible. A new tip sheet, “10
Patient Safety Tips for Hospitals,” was recently unveiled by AHRQ
Director Carolyn M. Clancy, MD, at the Joint Commission on Accreditation
of Healthcare Organizations’ annual patient safety conference in
Chicago. “The care provided in hospitals every day is more prone to errors
than other health settings because of the multiple people, processes,
and transitions in care delivery,” said AHRQ’s Dr. Clancy. The tips cover a range of activities including how to reduce the likelihood
of fatigue-related mistakes, ensuring safety in intensive care units
(ICUs), using technology to improve clinical care, and more. Each tip
provides a brief synopsis of key data or findings from AHRQ-supported
research to help organizations recognize the benefit of changing their
current practices and references tools available to help hospitals make
changes. Examples of the tips include: AHRQ hopes the tip sheet will be posted in hospitals nationwide. It
is available free, in PDF form at http://www.ahrq.gov/qual/10tips.htm. HHS’ Agency for Healthcare Research and Quality (AHRQ) recently
announced the awarding of more than $5 million for 19 new grants under
its “Improving Patient Safety Through Simulation Research” request
for applications. The projects focus on assessing and evaluating the
roles that simulation can play to improve the safe delivery of quality
health care. Medical simulation involves scenarios in which real-life medical situations
are re-created so that health care providers can practice new procedures
and techniques before performing them on patients and potentially placing
them at risk. These projects will inform providers, health educators,
payers, policy makers, patients, and the public about the effective use
of simulation in preventing medical errors and improving patient safety.
Examples of scenarios researchers plan to simulate include: Several projects focus on teamwork in high-risk settings such as emergency
departments, labor and delivery units, and intensive care units. These
projects will have an immediate and long-term impact by accelerating
the implementation of new simulation tools to improve patient safety. The projects span a wide spectrum of settings and populations in 16
states throughout the United States. For a complete list of the projects,
visit: http://www.ahrq.gov/qual/simulproj.htm In an issue brief on disparities, the Alliance for Health Reform discusses
the type of disparities that underserved populations face as well as
programs currently in place to reduce disparities and thoughts on future
actions. Developed with funding by the Robert Wood Johnson Foundation, the report “Racial
and Ethnic Disparities in Health Care” lists barriers to reducing
disparities, including: However, recognition of disparities reduction as an important element
in the overall effort to improve health care quality is growing, as are
data collection and private sector efforts towards equality. “National leadership is needed to push for innovations in quality
improvement, and to take actions that reduce disparities in clinical
practice, health professional education, and research,” the brief
concludes. The issue brief is available at: www.allhealth.org/publications/pub_38.pdf  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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