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P4P Plus Public
Reporting Leads to Modest Increase in Hospital Quality Study Shows
Value of EHR in Identifying High Quality Care AHRQ, Health Care Leaders
Promote ‘Rapid Learning’ System
Using EHRs Evidence on Best QI Techniques for Infections Is Slim Michigan Employers
Pledge to Support Four Cornerstones of Health Care Transparency Grants
to Help States Build More Efficient, High Quality Medicaid Systems Preventive
Care Timeline Available from AHRQ QIO Medical Director to Serve on NIH
Advisory Committee to the Director 18 New EHRs Certified by CCHIT HHS Makes Grant Funds Available for Gulf
Coast States An early release article in the January 26th issue of the New England
Journal of Medicine shows that using pay-for-performance (P4P) efforts
in tandem with public reporting drives improvement in hospital quality.
The study, “Public Reporting and Pay for Performance in Hospital
Quality Improvement,” involved hospitals participating in the CMS/Premier
Hospital Quality Improvement Demonstration (HQID). Study authors include: Dale W. Bratzler, DO, MPH, Medical Director for
the Hospital Improvement QIOSC at the Oklahoma Foundation for Medical
Quality, the state’s QIO; Peter K. Lindenauer, MD, MSc; Denise Remus,
PhD, RN; Sheila Roman, MD, MPH; Michael B. Rothberg, MD, MPH; Evan M.
Benjamin, MD; and Allen Ma, PhD. For the two-year study, authors analyzed adherence to measures of good
quality care at 613 hospitals that voluntarily participated in public
reporting. Of the 613 facilities included in the study, 207 were also
participating in HQID and served as the study group; the remaining 406
hospitals, which were only participating in public reporting, served as
the control group. Performance on 10 individual measures of quality, five for heart attack,
two for heart failure, and three for pneumonia were analyzed. Facilities
involved in both P4P and public reporting showed greater improvement in
all the measures as well as a composite of all 10. Improvement in seven
of the 10 measures was noted as “significantly greater” than
control hospitals. After adjusting for baseline performance and hospital
differences, “pay for performance was associated with improvements
ranging from 2.6 to 4.1% over the 2-year period,” the authors concluded. “Although the effect of the incentives was modest, our results
suggest that financial incentives are capable of catalyzing quality-improvement
efforts among hospitals already engaged in public reporting,” wrote
the authors. More research on the inherent complexities of P4P and its
effects on quality should be done before “widespread application
of financial incentives is considered,” researchers cautioned. Editorial In the absence of this information, Dr. Epstein suggests that “a
series of regional models could accelerate learning and allow Medicare
officials to find out more about the effect of differing levels of incentives
and formulas for payment” instead of rushing to adopt a single new
payment system for Medicare. Dr. Bratzler will discuss the findings of this study in a Plenary Session
at the AHQA Annual Meeting in New Orleans. Study Shows Value of EHR in Identifying High Quality Care A study in the January/February issue of the Journal of the American
Medical Informatics Association quantifies the difference between calculating
quality measures for diabetes using claims data and data extracted from
an electronic health record (EHR). “Comparison of Methodologies
for Calculating Quality Measures Based on Administrative Data versus Clinical
Data from an Electronic Health Record System: Implications for Performance
Measures,” was
conducted by the Palo Alto Medical Foundation and Lumetra, California’s
QIO, as part of the Doctor’s Office
Quality project. Researchers Paul Tang, MD, MS; Mary Ralston, PhD; Michelle Fernandez
Arrigotti, MPH LUBNA QURESHI, MS; and Justin Graham, MD, MS; extracted
a random sample of medical charts from Medicare beneficiaries with diabetes.
Then, based on a random sample of 125 charts, they identified diabetics
two ways using the same predefined inclusion criteria -- by administrative
claims data and coded clinical data in an EHR. Only 75 percent of Medicare beneficiaries with diabetes were identified
using administrative data, while coded information in the EHR revealed
97 percent of the diabetics with a specificity of 99.6 percent. Differences
in the detection of quality measures for HbA1c testing, blood pressure,
urine testing, and eye exams were also found to be statistically significant. “New
development of standardized quality measures should shift from claims-based
measures to clinically based measures that can be derived from coded information
in an EHR,” conclude the authors. “Without adding burden to
the care process, clinical data entered by clinicians into an EHR system
at the point of care should be mined to generate new knowledge, measure
performance, and reward those who deliver the best care with the best
outcomes,” they continue. AHRQ, Health Care Leaders Promote ‘Rapid Learning’ System
Using EHRs Health care leaders highlight the benefits and practical applications
of developing a national “rapid learning” health system developed
through expanded use of electronic health records (EHR) in a special edition
of Health Affairs. It is anticipated that “rapid learning” would help narrow
the gap between clinical research and evidence-based medicine by expanding
the health care system’s research capacity. This would make it possible
to combine information from millions of patients each year to get a clearer
understanding of health issues such as the impact of chronic diseases
like diabetes, why health care costs are increasing, the risks and benefits
of prescription drugs, and environmental effects on disease patterns. Rapid learning would also help physicians personalize medicine, possibly
reducing health disparities and give patients information to make better
treatment decisions. Expanded use of EHRs could also lead the way for
computerized predictive models and virtual clinical trials to speed identification
of best practices and treatments and the development of new medications. Papers in the special issue include: The special edition was supported by the Robert Wood Johnson Foundation’s
Pioneer Portfolio, Kaiser Permanente, and the Agency for Healthcare Research
and Quality. It is available at: There is a dearth of high quality research indicating the best quality
improvement strategies to reduce health care associated infections says
a new evidence report from the Agency for Healthcare Research and Quality
(AHRQ). After a review of 64 studies on surgical site infections, central line-associated
bloodstream infections, ventilator-associated pneumonia, catheter associated
urinary tract infections, and healthcare-associated infections, AHRQ found
that most included reports of infection rates but not rate of adherence
to preventive interventions. Based on the data available, the following
interventions were deemed “worthy of future study, and possibly
wider implementation”: “Closing The Quality Gap: A Critical Analysis of Quality Improvement
Strategies: Volume 6—Prevention of Healthcare-Associated Infections” is
available online at: http://www.ahrq.gov/clinic/tp/hainfgaptp.htm#Report#Report Executives from GM, Ford, Chrysler Group, and about 30 other Michigan
employers recently pledged to support the national transparency initiative
by making quality and price information about physicians, hospitals, and
other medical providers available to all users of their health insurance
programs. Nearly two million individuals have health care coverage through
these companies. The employers will also support health IT by encouraging the use of recognized
interoperability standards in products used by their health plans and
will develop incentives for achieving better value in health care. HHS Secretary Michael Leavitt recognized the Greater Detroit Area Health
Council (GDAHC) as a Community Leader, a designation bestowed to organizations
who agree to support the cornerstones at the local and regional level.
MPRO, the Michigan QIO, is a member of the GDAHC. This move from the Michigan private sector supports the four cornerstones
of the national transparency initiative launched by President Bush last
year through Executive Order. President Bush called for greater access
to cost and quality data to support better consumer decisions on health
care. Last week, HHS Secretary Mike Leavitt awarded 33 Medicare Transformation
Grants to 27 states to develop new ways to improve Medicaid efficiency,
economy, and quality of care. Authorized under Section 6081 of the Deficit Reduction Act, these initial
grants total $103 million to be used over two years. HHS plans to award
another $47 million for these grants later in the year. States will use the funds to implement innovative systems to get more
value out of the money they spend providing health care to their low-income
elderly, children, and disabled citizens. “These transformation grants express the core goal of this administration
to give states the kind of flexibility they need to deliver high quality
care in an efficient and economical way,” Secretary Leavitt said. “With
these grants states can streamline and modernize their systems, stabilize
the exponential growth of the program and protect it into the future.” In part, the funds will support more widespread use of technology, including
electronic health care records, clinical decision support tools, and e-Prescribing
that improve quality of care and reduce the potential for medical errors.
Other areas in which grant funds will be used include: improving access
to care; increased utilization of generic drugs; implementation of medication
risk management programs; and reducing waste, fraud and abuse. More information is available at: www.cms.hhs.gov/MedicaidTransGrants. New materials for adult preventive care measures are now available from
the Agency for Healthcare Research and Quality. The “Adult Preventive Care Timeline” is a wall chart suitable
for display in physician offices that indicates when age appropriate preventive
health services such mammography, smoking cessation counseling, and flu
and pneumonia immunization should take place. Information in the chart
reflects recommendations of the U.S. Preventive Services Task Force. The chart is available free online at: www.ahrq.gov/clinic/pocketgd.pdf
Single, pre-printed copies of the chart are available free of charge from
AHRQ. Call 1-800-358-9295 or email ahrqpubs@ahrq.hhs.gov. John C. Nelson, MD, MPH, Medical Director at HealthInsight, the QIO for
Nevada and Utah, has been selected to serve on the National Institutes
of Health Advisory Committee to the Director (ACD). Six other individuals
were also recently appointed. Dr. Nelson is a board certified obstetrician and gynecologist from Salt
Lake City, Utah. He has served as deputy director of the Utah Department
of Health and was president of the Salt Lake County Medical Society, the
Utah Medical Association, and served as the 159th president of the American
Medical Association. He has also served on numerous federal committees,
most recently the Medicaid Advisory Commission. Dr. Nelson has long been
concerned with access to health care coverage for all Americans, the elimination
of racial and ethnic disparities in health care, prevention of disease,
and quality improvement in health care delivery. “I see my service as an opportunity to identify research and knowledge
that is relevant to the practicing MD. My responsibilities at the NIH
are an extension of my responsibilities to patients. As a QIO Medical
Director I bring a unique lens for seeing those areas of research that
will have the greatest leverage in improving patient care,” commented
Dr. Nelson on his appointment. “I am humbled by the responsibility
and deeply honored to serve on the committee.” Established in 1966, the ACD comprises the Secretary of Health and Human
Services and 20 individuals appointed to advise the NIH Director on policy
matters important to the NIH mission of conducting and supporting biomedical
and behavioral research, research training, and translating research results
for the public. Members can serve for up to four years. The six other new members include: Karen A. Holbrook,
PhD, president of The Ohio State University, and professor of Physiology
and Cell Biology and Medicine (Dermatology) in the College of Medicine; Ralph I. Horwitz, MD, the Arthur Bloomfield Professor and chair of the
Department of Medicine at Stanford University; Mary-Claire King, PhD,
the American Cancer Society Professor in the Departments of Medicine
and Genome Sciences at the University of Washington; Alan, I. Leshner,
PhD, hief executive officer of the American Association for the Advancement
of Science (AAAS) and executive publisher of its journal, Science; and Barbara L. Wolfe, PhD, Professor of Economics, Population Health Sciences,
and Public Affairs and Faculty Affiliate at the Institute for Research
on Poverty at the University of Wisconsin-Madison (also is currently
serving as Director of the La Follette School of Public Affairs). “These seven outstanding new members to the NIH Advisory Committee
to the Director join a dedicated team of esteemed advisors,” said
NIH Director Elias A. Zerhouni, M.D. “The NIH relies on the willingness
of these great minds and the efforts of other scientists and public members
who participate on advisory councils and peer-review committees.” Additional
information is available at www.nih.gov/about/director/acd/index.htm. The Certification Commission for Healthcare Information Technology (CCHIT)
recently announced the certification of 18 additional electronic health
record (EHR) products for office-based physicians. “The rapid acceptance of certification in the marketplace has far
exceeded our expectations. Electronic health record companies have stepped
up to the plate, ensuring that their products meet CCHIT criteria and
actively promoting certification as a mark of excellence,” said
Mark Leavitt, MD, PhD, CCHIT chairman. “The benefits of certification
will increase as we continue to raise the standards for functionality,
interoperability, and security.” CCHIT was established in 2004 to accelerate the adoption of health IT
by creating a product certification program that would ensure the interoperability,
privacy, and ROI of EHR products resulting in reduced risk for physicians
and other providers implementing health IT. CCHIT works under contract
to the Department of Health and Human Services to certify products for
ambulatory EHRs, inpatient EHRs, and the network components through which
they interoperate and share information. A total of 55 office-based products have been certified by CCHIT. All
certified products are listed on www.cchit.org. HHS recently announced the availability of $175 million in grant funds
to help acute care hospitals and skilled nursing facilities (SNF) in Alabama,
Louisiana, and Mississippi that are suffering economic pressure as a result
of Hurricane Katrina. “Since Hurricane Katrina, providers’ in the Gulf Coast have
experienced difficulty hiring and retaining staff,” HHS Secretary
Michael Leavitt said. “Changing wage rates have impacted health
care provider’s ability to attract potential workers. These grants
will help hospitals and skilled nursing facilities respond to that pressure,
and strengthen access to health care services in the Gulf Coast region.” Based on each eligible hospital and SNF’s share of total Medicare
payments under a prospective payment system for inpatient care, the Centers
for Medicare & Medicaid Services (CMS) will allocate funds in the
following proportions and amounts: 45 percent, $71.6 million for Louisiana
facilities; 38 percent, $60.5 million for Mississippi facilities; and
17 percent, $27.8 million for Alabama facilities. Each state must submit
applications to CMS to receive the grant funds. The Secretary also established a $15 million grant for Louisiana’s
greater New Orleans area to help attract doctors and other health care
providers. According to the Louisiana Health Care Redesign Collaborative,
approximately 50 percent of the physicians who worked in the region before
Katrina are no longer practicing there.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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