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Study Documents Impact of Fragmented Care on P4P Initiatives Remaking American Medicine Receives National Recognition New Certification Criteria Approved for Ambulatory EHRs Reports: Hospitals Improving on Mortality, Pattern for Success Identified NPI: Enforcement Guidance Gives Providers More Time
In a recent report, the Joint Commission found that hospitals improved significantly in heart attack, heart failure, and pneumonia care over the past four years. This first annual report by the Joint Commission also shows that care varies greatly by state. For example, it found that almost all heart attack patients are receiving aspirin when they arrive at the hospital, but many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital. The report is based on the Hospital Quality Measures, common to both the Joint Commission and the Centers for Medicare and Medicaid Services. The report is available at: http://www.jointcommissionreport.org/ A March 15 New England Journal of Medicine study found that Medicare beneficiaries’ care is so widely dispersed – especially for those with chronic conditions – that current methods for determining which physician should qualify for additional payment in pay-for-performance (P4P) initiatives are inaccurate and inconsistent. The study, “Care Patterns in Medicare and Their Implications for Pay for Performance,” was conducted by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. The nationally representative study found that a Medicare patient seen by the typical physician was treated by seven different doctors in four different medical practices in a given year. Only about 35 percent of beneficiaries’ visits were with the doctor held responsible for their care under the most common P4P methodology. Moreover, for 33 percent of beneficiaries, the assigned physician and practice changed from year to year. Using a variety of different methods to assign patients to physicians or practices, the study concluded that typically primary care physicians would be held accountable for 39 percent of the Medicare patients they treat and 62 percent of Medicare visits they bill, while medical specialists, who often provide more costly care, would be held accountable for 12 percent of the Medicare patients they treat and 20 percent of the total Medicare visits they bill. “The study raises serious questions about how meaningful a Medicare pay-for-performance program would be for patients in the current fee-for-service system where care is so widely dispersed,” said Hoangmai H. Pham, MD, MPH, the study’s lead author and senior health researcher at HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation. “If physicians don’t know which patients they have primary responsibility for ahead of time, and Medicare only figures this out after the fact, then it is hard to envision how P4P incentives will motivate physicians to improve the quality of care they deliver,” Pham said. “Physicians would not know which patients to target with particular services or whether making large investments, such as in health information technology, will really pay off if most of the patients they are responsible for don’t stay assigned to them over time.” Instead of using the current system, the authors suggest that Medicare consider prospectively assigning patients to physicians and practices to establish clearly which providers will be held accountable for coordinating patients’ care. “Prospective designation of the responsible providers, even if voluntary, implies some limitation of the freedom of both patients and physicians to choose the physicians with whom they work, but it would have the benefit of aligning physician, patient and payer expectations of care relationships,” the article concludes. Read an abstract of the article at: http://content.nejm.org/cgi/content/abstract/356/11/1130 Remaking American Medicine™ ~ Health Care for the 21st Century (RAM), a four-part PBS series that aired every Thursday in October 2006, was selected as the best television program of the year by the Association of Health Care Journalists at the eighth annual conference in Los Angeles. The American Health Quality Association is a national RAM partner. The series was supported by national, regional, and local coalitions to spur and expand the burgeoning heath care quality movement – including the efforts of 27 QIOs across the country. The RAM effort is “is much more than a compelling documentary,” said AHQA EVP David Schulke in a public statement. “From the beginning, the organizers made a conscious effort to promote local awareness of the program to help people in communities understand the depth of our quality problems and encourage them to continue to push hard for progress long after the last episode airs.” Reaching new heights in the portrayal of health care quality in action, “the producers secured permission to give the public an inside view of people working together to get control of unreliable clinical processes that too often just don’t work,” said Schulke. The program “looks for more effective solutions than the common ‘shame and blame’ response to quality problems,” he continued. QIOs supported RAM by collaborating with their local PBS stations and other partners to host community events and produce television programs highlighting health care issues specific to their communities. These coalitions also staffed viewer call-in panels, developed community resources including: health care tip sheets, bilingual flyers and brochures, and resource guides. The judges described RAM as: “A beautifully written and produced piece that sheds light on some of the nation’s most vexing health care issues. The episodes successfully exposed problems and examined solutions. Kudos to the makers of Remaking American Medicine. We should all aspire to produce health stories of similar caliber. Impressive, informative and compelling work!” The series was produced by Crosskeys Media with Frank Christopher as executive producer, Matthew Eisen as co-executive producer, and Marc Shaffer as series producer. Peabody and Emmy award-winner John Hockenberry served as the series host. Devillier Communications, Inc., coordinated the national outreach campaign and KQED presented the series to the PBS system. The series was funded by the Amgen Foundation and The Robert Wood Johnson Foundation. The Nathan Cummings Foundation, Josiah Macy, Jr. Foundation and Blue Cross Blue Shield of Massachusetts provided additional funding. Additional support was provided by the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality. The Association of Health Care Journalists awards recognize the finest health reporting in nine categories covering print, broadcast, and online media. In only its third year, the contest drew nearly 400 entries, which were screened and judged by 44 health care journalists. Remaking American Medicine won in the Television (Top 20 markets) category. A CNN Anderson Cooper 360 report, “Sick and Uninsured” by Sanjay Gupta, Shahreen Abedid, and Abigail Leonard, won second place. “Battling Alzheimer’s” by Susan Dentzer of PBS’ The NewsHour with Jim Lehrer placed third. For more information about the TV series: www.remakingamericanmedicine.org The Certification Commission for Healthcare Information Technology (CCHIT) unanimously approved new 2007 criteria for ambulatory electronic health records (EHRs). The final criteria, test scripts, and associated documents are posted on the CCHIT Web site, www.cchit.org; the criteria take effect May 1, 2007. Among a number of new requirements this year, systems must be able to send prescriptions and refills to pharmacies electronically and products must be able to electronically receive standards-based lab result messages. CCHIT also released a roadmap for expansion of the EHR criteria in other settings. The roadmap calls for the launch of child health criteria in May 2008 and beginning of development for behavioral health and long term care by late 2007 or early 2008. More details are available in the “Expansion of CCHIT Certification to Professional Specialties, Care Settings, and Patient Populations Expansion Roadmap,” at http://www.cchit.org/work/criteria.htm. A Town Call teleconference to discuss the new criteria is scheduled for April 5, at 11 a.m. Eastern. Led by Mark Leavitt, MD, PhD, chair, CCHIT, the call will include a short presentation and extensive Q&A opportunity. To join the call, dial 1-877-313-5342 and use conference ID Number: 2678252. For more details on the call and to download the presentation, visit: http://www.cchit.org/events/Town+Calls.htm. Additional information about the expansion will be released following an April 16 Commission meeting. CCHIT is an independent, nonprofit organization that serves as an official certification body for electronic health record products. CCHIT develops its certification criteria based on widely accepted industry standards and input from hundreds of expert volunteers and stakeholders throughout the health care industry. Researchers recently evaluated quality improvement efforts in hospitals and found that hospital mortality rates are improving. They also identified successful strategies and lessons learned through four case studies of highly performing hospitals, according to two reports from The Commonwealth Fund. The report Hospital Performance Improvement: Trends in Quality and Efficiency--A Quantitative Analysis of Performance Improvement in U.S. Hospitals included an analysis of data from three different acute care databases over three-year periods between 2001 and 2005. The authors found “significant improvements in mortality rates broadly across hospitals, likely indicating that hospitals have been getting better at keeping people alive through error reduction, improved technologies, adherence to evidence-based protocols, and other strategies” but “mixed results for complications and morbidity.” In the companion report, Hospital Quality Improvement: Strategies and Lessons from U.S. Hospitals, researchers studied four hospitals that made substantial improvements and were able to identify a pattern for success that includes five elements: involvement of a trigger that prompts hospitals to make organizational and structural changes that facilitate a systematic problem-identification and problem-solving process, resulting in new treatment protocols and practices, which improved outcomes. As part of the case studies, researchers asked representatives from the four hospitals what roles public policy could play to influence quality improvement efforts. The suggestions included: In an e-Forum, Tony Shih, MD, MPH, the Fund’s senior program officer for quality improvement and efficiency, joins Sharon Silow-Carroll, MBA, MSW, Health Management Associates; Eugene A. Kroch, PhD., CareScience, Inc.; Ashish Jha, MD, MPH, Harvard School of Public Health; and Dale Bratzler, DO, MPH, Hospital Interventions QIOSC and the Hospital Quality of Care Measures Special Study, Oklahoma Foundation for Medical Quality, the state’s QIO, discuss the reports’ findings in a recorded, synched PowerPoint slide show. The reports “demonstrate that the quality of hospital care has improved, but they also reveal there is still much work to be done. As noted by others, there remains considerable variation in quality and efficiency across hospitals,” commented Dr. Bratzler. “While the work revealed in these two reports and the results of prior studies have taught us about the characteristics of high-performing hospitals, we know little about how to transfer this knowledge to hospitals at the low end of the quality spectrum,” he continued. For instance, “How do we motivate the leadership of poorly performing hospitals to embark on the sequence of events that resulted in rapid improvement in case study hospitals?” questioned Dr. Bratzler. “Hospital executives and board members must take as much responsibility for the quality of care in their institution as they take for the fiscal health of the organization,” he said. “The Medicare QIO program may provide some of the necessary infrastructure to continue to learn about the characteristics of highly performing or improving hospitals. In addition, the QIOs may be in a position to disseminate the findings and lessons highlighted in these two companion reports and to provide technical assistance to hospitals to improve processes of care and overcome barriers,” said Dr. Bratzler. A collaborative workgoup, which includes QIOs and other stakeholders, is already developing organizational assessment tools that hospitals can use to identify their strengths and weakness. These two studies will likely inform that effort, which will allow quality improvement experts to “begin to learn how to transfer this knowledge to poorly performing hospitals.” Read the reports and access the e-Forum at: http://www.cmwf.org/publications/publications_show.htm?doc_id=471264 The Centers for Medicare & Medicaid Services (CMS) recently released enforcement guidance for compliance with the National Provider Identifier (NPI), which Medicare providers must use beginning May 23, 2007. The final rule establishing the NPI as the standard unique health provider identifier for health care providers was published in 2004 and requires all covered entities to be in compliance with its provisions by May 23, 2007, except for small health plans, which must be in compliance by May 23, 2008. The NPI replaces all “legacy” identifiers that are currently being used, thereby eliminating the current need for multiple identifiers for the same provider. CMS made the decision to announce this guidance on its enforcement approach after it became apparent that many covered entities would not be able to fully comply with the NPI standard by May 23, 2007. This guidance would protect covered entities from enforcement action if they continue to act in good faith to come into compliance, and they develop and implement contingency plans to enable them and their trading partners to continue to move toward compliance. The guidance “clarifies that covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows,” said CMS Acting Administrator Leslie V. Norwalk, Esq. The guidance was issued after it became apparent that many covered entities would not be able to fully comply with the NPI standard by May 23, 2007. Enforcement action will not be taken against entities that can show a “good faith” effort at compliance and have a contingency plan that extends no later than May 23, 2008. A critical aspect of implementing the NPI is the ability for covered entities to match a provider’s NPI with the many legacy provider identifiers that have been used to process administrative transactions. CMS plans to make data available from the National Plan/Provider Enumeration System (NPPES) system so that covered entities can cross reference the data. Medicare providers are encouraged to get their NPI before the deadline by visiting: https://nppes.cms.hhs.gov/. Detailed specifications for the 74 measures included in the 2007 Physician Quality Reporting Initiative (PQRI) were recently released by the Centers for Medicare and Medicaid Services (CMS). PQRI, which succeeded last year’s Physician Voluntary Reporting Program, establishes a financial incentive for physicians and other health practitioners to participate in a voluntary quality reporting program. Eligible professionals who successfully report data on the PQRI measures between July 1, 2007 and December 31, 2007 may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare services. The measures are evidence- and consensus-based measures developed by the American Medical Association Physician Consortium for Performance Improvement, the National Committee for Quality Assurance, the National Quality Forum, the AQA Alliance, and other physician and non-physician professional organizations. The professional organizations are also assisting CMS in providing PQRI education and assistance to their members. In the recently release contract modification, CMS has also tasked QIOs with helping physicians report and understand these measures. The measure specifications and other information is available at www.cms.gov/pqri/. During the month of May, the Administration on Aging sponsors Older American’s Month, an opportunity to highlight ongoing contributions of older citizens with a national proclamation issued by the President of the United States and community activities and events across the country. The theme for the 2007 observance is “Older Americans: Making Choices for a Healthier Future,” which aims to focus on health and long term care while encouraging individuals to work together to rebalance and modernize current systems to adequately plan for and address the needs of current and future generations. Resources for Older Americans Month, including a drop-in article, posters, and logo are available at: http://www.aoa.gov/PRESS/oam/May_2007/Materials_Downloads.asp  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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