Quality Update for February 22, 2007

QIO Bill Introduced in House CMS Moves Forward with Transparency Efforts, Announces BQI Contracts HHS Unveils Two New Efforts to Advance Pandemic Flu Preparedness PQRI Web Page Now Available IPRO Receives ‘Empire State Silver’ Certification for Quality Research Addresses Health Care Quality Issues Call for Eisenberg Award Nominations QIO Bill Introduced in House Representative Michael Burgess, MD, (R-TX) introduced legislation in the U.S. House of Representatives to modernize the QIO program on February 14 th. AHQA strongly supports the stand-alone bill, H.R. 1046, which is titled The Medicare Quality Improvement Organization Modernization Act of 2007. H. R. 1046 will permit QIOs to assist more providers as well as ensure that the national QIO infrastructure plays a meaningful role in ongoing federal health care reform efforts, such as the HHS Secretary’s current push for greater transparency in health care transactions. Many of the major reforms in H.R. 1046, such as making the beneficiary complaint process more responsive to complainants, ensuring the diversity and integrity of QIO governing bodies, and enhancing QIO program administration and evaluation, were also included in Title II of H.R. 5866 introduced by Rep. Burgess in July of 2006. All legislation still pending at the end of the previous two year Congress must be reintroduced to be considered in the current Congress, the 110 th convened since the founding of the nation. Back to top In addition to the QIO provisions in Title II, H.R. 5866 included sections on reform of payment systems for physicians and other aspects of Medicare. “The QIO section of that bill was so important,” Rep. Burgess told a gathering of QIOs, that it warranted consideration on its own. Thus, Rep. Burgess introduced his newest QIO proposal, H. R. 1046, as a stand-alone bill. Text of the legislation is available at: http://thomas.loc.gov/cgi-bin/query/C?c110:./temp/~c110bAKz8w QIOs “are the logical way to provide the type of oversight that CMS wants for its Medicare programs,” Rep. Burgess told QIOs. “Don’t underestimate your strength,” he continued, “I believe it is substantial.” Significant provisions of H. R. 1046 include: Beneficiary complaint reform: making the complaint resolution process more transparent and accountable to beneficiaries and their families, and teaching providers proven methods for promptly resolving consumer concerns. QIO governance: ensuring that QIO governing bodies meet the highest standards for integrity, including expanded diversity, compensation rules, and consumer representation. Leveraging Medicare quality projects: allowing QIOs to provide technical assistance beyond the Medicare contract. Toughened competition and evaluation: increasing competition for QIO contracts and strengthening program design, management, and evaluation. Assuring adequate funding: limiting diversion of funding from work in the field and guaranteeing that increases in QIO work assignments are matched by adequate resources. Setting priorities that matter: ensuring state and national stakeholder and expert input on priorities and measurable objectives for QIO work. Outreach for co-sponsors and support of H.R. 1046 is the next step, said Rep. Burgess. Based on the number of positive comments he received following introduction of last year’s bill, he is optimistic about the prospects for this new measure. H.R. 1046 does not call for additional funding, which eliminates budgetary concerns – a stiff barrier for many legislative endeavors. But, given that the 2008 presidential election year begins in less than a year, Rep. Burgess reminded QIOs that there is a “very limited window” where Congress might focus on this measure. “We are very grateful to Dr. Burgess for his leadership in modernizing the QIO program. In the 25 years since most of the governing statute for the QIO program was written, we’ve learned a lot about our health care system and how to deliver better care,” said Schulke. “We’ve moved beyond the bad old days when the first response to all quality problems was regulatory action. We’ve learned to reserve punishment for the small number of negligent individuals who must be disciplined. Today, QIOs are measuring performance, computerizing medical practice, and helping professionals reorganize their work to reliably provide high quality care. Studies show the new approach works, and the Burgess legislation builds on that success.” Back to top CMS Moves Forward with Transparency Efforts, Announces BQI Contracts The Centers for Medicare & Medicaid Services (CMS) recently announced that Delmarva Foundation for Medical Care, the QIO for Maryland and the District of Columbia, had entered into subcontracts with four regional collaboratives as part of the Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) Project. The regional collaboratives will combine Medicare data with data from other insurers to produce information on the performance of health care providers for the benefit of Medicare beneficiaries. The following regional collaboratives have signed subcontracts: Indiana Health Information Exchange (IHIE), Massachusetts Health Quality Partners (MHQP), Minnesota Community Measurement (MNCM), and Wisconsin Collaborative for Healthcare Quality (WCHQ). “This is an important advancement,” said CMS Acting Administrator Leslie V. Norwalk, Esq. “The BQI project will give Medicare beneficiaries a broad overview of provider performance resulting in better choices in meeting their health care needs. The regional collaboratives, spurred by great leadership from physicians and others in the health care community, will also provide critical information to physicians and Medicare on the best practices for data collection, aggregation, and reporting.” The BQI Project is part of HHS Secretary Mike Leavitt’s Value-driven Health Care Initiative which is based on the four cornerstones announced in President Bush’s Executive Order issued August, 2006: interoperable health information technology (health IT); transparency of price information; transparency of quality information; and the use of incentives to promote high-quality and cost-efficient health care. The quality measures to be used in the BQI project are national consensus-based measures that have been adopted by AQA. CMS plans to announce two additional BQI subcontractors in the near future. Additional information on each regional collaborative as well as the Secretary’s Value-driven Health Care Initiative is available at www.hhs.gov/transparency. Back to top HHS Unveils Two New Efforts to Advance Pandemic Flu Preparedness The Department of Health and Human Services (HHS) recently announced new guidelines and a public outreach effort designed to improve state, local, and community preparedness for pandemic influenza. The guidelines, developed by the Centers for Disease Control (a component of HHS), provide community-level actions that can be taken to reduce infection during an incident of pandemic flu. Included in the guidelines is a new pandemic influenza planning tool – the Pandemic Severity Index (PSI). The PSI, based on the model used to grade hurricanes, categorizes pandemics on a scale of 1 to 5, with category 1 being as harmful as a severe influenza season and category 5 characterizing a pandemic of the same intensity as the 1918 flu pandemic or worse. The severity of a pandemic is primarily determined by its death rate, or the percentage of infected people who die. Based on the projected severity of the pandemic, government and health officials may recommend different actions communities can take to limit the spread of disease. These actions may include: Asking ill persons to remain at home or not go to work until they are no longer contagious. Asking household members of ill persons to stay at home for seven days. Dismissing students from schools and closing child care programs for up to three months for the most severe pandemics and reducing contact among kids and teens in the community. Recommending social distancing of adults in the community and at work, which may include closing large public gatherings, changing workplace environments, and shifting work schedules without disrupting essential services. Planning guides for businesses and other employers, child care programs, elementary and secondary schools, colleges and universities, faith-based and community organizations, and individuals and families are included in the appendix of the CDC guidance. “The threat of a pandemic continues to be real. We need to continue helping state and local decision-makers determine some of the specific actions they could take during the course of a pandemic to reduce illness and save lives,” said HHS Secretary Mike Leavitt. The CDC guidance was developed through a collaborative process that included public health officials, mathematical modelers, researchers, and stakeholders from government, academia, private industry, education, and civic and faith-based organizations. HHS also unveiled a number of new radio and television public service announcements (PSAs) to raise awareness and educate the public about pandemic influenza and the need to prepare in advance. “We need to keep up our efforts to educate the public before a pandemic emerges, and these PSAs will help people ‘know what do to about pandemic flu,’” Secretary Leavitt said. The PSAs and the community planning guidance, titled Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early Targeted Layered use of Non-Pharmaceutical Interventions, are available at www.pandemicflu.gov. Back to top PQRI Web Page Now Available The 2007 Physician Quality Reporting Initiative (PQRI) webpage is available. PQRI (and this related page) replaces the Physician Voluntary Reporting Project (PVRP), which is scheduled to end on February 28 th. PQRI establishes a financial incentive for eligible professionals participating in the voluntary quality reporting program from July 1 to December 31, 2007. Unlike PVRP, the new program is open to providers beyond physicians. Under the 8 th Scope of Work, QIOs are tasked with promoting PRVP to physician offices. In an Open Door forum earlier this year, a CMS staffer said that additional guidance would be provided to the QIOs regarding PQRI (see “CMS Discusses Transition from PVRP to PQRI” in the February 1, 2007 AHQA Matters). More information is available at: http://www.cms.hhs.gov/pqri/. Back to top IPRO Receives ‘ Empire State Silver’ Certification for Quality IPRO, the New York QIO, recently received the Empire State Advantage’s (ESA) Empire State Silver Certification, the only award program in the state that is based on the Malcolm Baldrige National Quality Award criteria. The Empire State Silver certification is awarded to organizations that have effective management systems and work processes, are achieving good results, and have developed methods to significantly improve over time. “Our review team was very impressed by both the people and the operations at IPRO,” said George Hansen, Executive Director, ESA. “We understand that ESA’s evaluation of IPRO was based on a stringent set of standards, and we are honored to receive this designation,” said Theodore O. Will, Chief Executive Officer, IPRO. “We believe this makes us a ‘role model’ for future winners to learn from and emulate. Moving forward, we look forward to mentoring others on this process.” Among recent Silver Certificate recipients are Strong Memorial Hospital, Arc of Monroe County and Nationwide Credit, Inc. ESA is a public/private partnership formed to help build economic competitiveness and improve the quality of life within New York State. Watch video of award ceremony at: http://company.ipro.org/index/esa. Back to top Research Addresses Health Care Quality Issues The Commonwealth Fund In a January report from The Commonwealth Fund, Stuart Gutterman and Michelle Serber look at demonstrations, pilots, and other initiatives CMS is using to improve the quality and efficiency of Medicare while reining in cost. The report “Enhancing Value in Medicare: Demonstrations and Other Initiatives to Improve the Program” provides an overview of all Medicare initiatives – including those provided through the QIO program. Gutterman and Serber conclude that “New initiatives to improve the program should build on the experiences and lessons learned from demonstrations, with the ability to reshape interventions as they are implemented to maximize their effectiveness,” which is in line with the March 2006 Institute of Medicine report on the QIO program. Read more at: http://www.cmwf.org/publications/publications_show.htm?doc_id=449512&#doc449512 Health Services Research Dana Beth Weinberg, PhD, and colleagues found that lack of coordination across care settings can have a negative affect on clinical outcomes and patient satisfaction with care. This conclusion, from the February Health Services Research article, “Beyond Our Walls: Impact of Patient and Provider Coordination Across the Continuum on Outcomes for Surgical Patients,” is based on surveys of knee-replacement surgery patients six weeks after discharge. Problems with coordination of care were associated with greater joint point, lower functioning, and reduced satisfaction. The authors suggest that e fforts to improve coordination across the continuum of care is critical to assure good health outcomes. Read an summary of the article at: http://www.cmwf.org/publications/publications_show.htm?doc_id=453771&#doc453771 Journal of General Internal Medicine In the study “Physician-Patient Communication About Prescription Medication Nonadherence: A 50-State Study of America’s Seniors,” Ira B. Wilson, MD, and colleagues found that poor communications between elderly patients and their physicians led to non-adherence to prescription medication routines. The three main findings from the study, which was supported by The Commonwealth Fund and the Henry J. Kaiser Family Foundation and published in the January issue of the Journal of General Internal Medicine, include: 27 percent of seniors did not tell their physician if they skipped doses or stopped taking a medicine because of side effects or thought is was not working. 39 percent of seniors who stopped taking their medications as prescribed due to cost had not talked to their physician about alternatives. Patients who did speak with their physician about medication costs, were more likely to be switched to lower cost medications. Read the article free at: http://www.springerlink.com/content/f88n482w643p1477/fulltext.pdf Health Affairs Elliott S. Fisher, MD, MPH, and colleagues propose an alternative to current reform efforts to focus on holding individual providers accountable for quality of care through performance-measurement and pay-for-performance. In the paper “Creating Accountable Care Organizations: The Extended Hospital Medical Staff,” published in a December 2006 Health Affairs, propose that local health care delivery systems and the physicians who work within and around them be the focal point for quality improvement efforts. Among other benefits, the authors said that shifting the focus of quality efforts and measurement from clinicians to a “community of care” would help pinpoint problems attributed to poorly coordinated care and overuse that would not otherwise be identified. Read more at: http://www.cmwf.org/publications/publications_show.htm?doc_id=466054&#doc466054 Back to top Call for Eisenberg Award Nominations The Joint Commission and the National Quality Forum (NQF) are now accepting nominations for the 2007 John M. Eisenberg Patient Safety and Quality Awards, which recognize individuals and health care organizations that are making significant contributions to improving health care quality and patient safety. The deadline for submission is April 16. Nominees should exhibit the principles that Dr. Eisenberg supported, including “a dedication to improving the quality of health care and patient safety, leadership in advancing methods for measuring and reporting health care quality, expanding the public’s capacity to evaluate the quality and safety of health care, and promoting health care choices based upon information about safety and quality.” Categories include: Individual Achievement, for individual nominees that show exceptional leadership and scholarship in patient safety and health care quality. Initiative/Project-Related Achievements, for individuals or organizations that have made significant contributions to patient safety and health care quality through research or innovation at the local or national level. The Awards were established in 2002 by the NQF and The Joint Commission in memory of John M. Eisenberg MD, Director of the Agency for Healthcare Research and Quality. Nomination forms are available at: http://www.jointcommission.org/NR/rdonlyres/B835C90E-46B7-47E0-A020-10C92385AAEE/0/07_Eisenberg_Nomination_Form.pdf Back to top

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