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Quality Update for April 20, 2007 HHS Kicks Off National Prevention Campaign AHQA Partners in National
Health IT Week CMS Publicly Launches DOQ-IT University Proposed Rule Gives Hospitals
More Incentive for QI Webcast Launch Planned for New CAHPS Survey HHS Sends Report on e-prescribing
to Congress Medicare Announces Grants for SHIP; Adds Preventive Health
Benefits Education to Scope of Work HHS Names Kolodner as Permanent
National Coordinator for Health Information Technology IPRO Partners
in First National Study of P4P in Medicaid Programs Glaucoma: Focus
of 2007 Healthy Vision Month Podcast Features Research about Reducing
Catheter-Related Bloodstream Infections CCHIT Changes Structure, Plans
to Recruit More Staff At a recent kick off event in Washington, US Department of Health & Human
Services The CMS prevention and wellness initiative is dubbed “A Healthier
US Starts Here!” In addition to Secretary Leavitt and Acting Administrator
Norwalk, heads of other HHS agencies were also on hand to share support
for the initiative, including Julie Gerberding, MD, MPH, Director of
the Centers for Disease Control & Prevention; Elias Zerhouni, MD,
Director of the National Institutes of Health; and Josefina Carbonell,
Assistant Secretary, Administration on Aging. Myrl Weinberg, President
of the National Health Council and Rear Admiral Penelope Royall, Deputy
Assistant Secretary for Health Disease Prevention & Health Promotion
also spoke at the event. During his opening remarks, Secretary Leavitt highlighted the stories
of two beneficiaries in the audience, both of whom confirmed the importance
of using Medicare’s prevention and screening benefits, along with
exercise, to stay fit and healthy. One 89 year-old who suffers from arthritis
found out that she also had osteoporosis after undergoing Medicare’s
bone density exam. She now exercises daily and needs no pain medication, “get
those joints going,” she told the audience. Why Prevention? Cost is another factor. As baby boomers age and start to enroll in Medicare,
expenses will rise. Twenty-three percent of Medicare beneficiaries have
five or more chronic conditions, which accounts for $300 billion per
year in Medicare expenses, 68 percent of the Medicare spending, said
Ms. Norwalk. Yet, fewer than one in ten beneficiaries get all the prevention
and screening benefits, she said. There is a “prevention gap in
Medicare,” declared Norwalk, “we want to close that gap.” The Healthier US initiative aims to close the prevention gap. CMS hopes
to raise awareness of Medicare’s preventive benefits by marshalling
local stakeholders, community groups, providers, payers, and employers
through Healthier US to reach out to Medicare beneficiaries at the community
level in places where they live, work, play, and pray. The Administration on Aging will be supporting the Healthier US initiative
as the agency did with Medicare’s Part D enrollment campaign, said
Ms. Carbonell, to “make sure that avail themselves of all available
Medicare resources.” “The unprecedented efforts of our local and national partners
have helped ensure that 38 million Americans—more than 90 percent
of people with Medicare—have prescription drug coverage,” said
Norwalk in a press release. “Community-based outreach, individual
counseling, and compassionate support for beneficiaries and caregivers
enabled people to choose the drug coverage that was right for them. We’re
using the same strategy to reach millions of people with Medicare about
the importance of prevention—one person at a time,” she continued. Outreach At the direction of the CMS regional offices of external affairs (OEA)
are mobilizing grassroots efforts in states across the country. These
efforts include a bus tour, which will visit 48 states beginning this
week and extending throughout the summer. Healthier US representatives
will also visit Hawaii and Alaska. The bus tour provides an opportunity to convene the thousands of groups
across the country that will be helping to educate Medicare beneficiaries
about prevention and screening benefits one on one in the community.
Social Security representatives will also be on hand at the bus tour
stops to help enroll low income beneficiaries in Medicare’s Part
D program and determine if they qualify for a Low Income Subsidy. Materials • Share your complete family health history CMS has developed a preventive benefits checklist that Medicare beneficiaries
can use to open discussion with their care provider. A toolkit is also
available for partners to use in promoting the Healthier US initiative
is available on the CMS partner Web site. Visit: http://www.cms.hhs.gov/Partnerships/Toolkits/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1198657&intNumPerPage=10 CMS is also offering an electronic tracking system that allows beneficiaries
to see what preventive benefits they have used and gives reminders of
those for which they are eligible. Beneficiaries can begin tracking this
information by signing up at www.mymedicare.gov. When beneficiaries log
on, they can check which preventive benefits they need; check their Part
B deductible status; view eligibility and enrollment information—including
for the Part D prescription drug program; and take care of administrative
issues such as verifying an address, ordering replacement Medicare cards,
check on the status of claims, and get on-line forms and publications. AHQA joins more than 50 public and private sector organizations in sponsoring
the second annual National Health IT Week in Washington, DC, May 14-18,
2007. National Health IT Week is a collaborative forum where organizations
with diverse perspectives --associations, payers, provider groups, vendors,
consumer organizations and research foundations -- unite to support widespread
health IT adoption to improve health care efficiency, quality, cost-effectiveness
and patient safety in the US. “When these diverse groups speak with a collective voice it sends
a clear message to Congress that health IT adoption is critically important
in our nation’s effort to improve health care,” said David
Schulke AHQA EVP. “AHQA is proud to be a partner in such a group.” Activities throughout National Health IT Week consist of individually
planned and hosted conferences and meetings. The week’s unique
combination of industry events elevates national attention on the necessity
of health IT adoption. Events during National Health IT Week include: Since the inaugural National Health IT Week in June 2006, several significant
developments have occurred in health IT. This year’s event will
build on these developments to advance the discussion and actions needed
to improve health care delivery and patient safety: Visit www.HealthITWeek.org for more details, including a full list of
partners and continually updated calendar of the week’s activities.
Registration is per event and can be accessed via provided links at:
http://www.healthitweek.org/activities.asp The Centers for Medicare & Medicaid Services (CMS) recently launched
DOQ-IT University, or DOQ-IT U (the acronym is pronounced “dock
it you”), a free, interactive, Web-based tool designed to provide
solo and small-to-medium sized physician practices with the education
for successful HIT adoption, including lessons on culture change, vendor
selection and operational redesign, along with clinical processes. “DOQ-IT U’s interactive platform, self-paced curriculum,
and associated tools provide physicians with easy access to the resources
they need to help ensure that patients receive the highest quality of
care at all times,” said CMS Acting Administrator Leslie V. Norwalk,
Esq. In a press release announcing its availability, CMS credited the role
of the QIO program in development and implementation of the tool, saying, “DOQ-IT
U is being developed and managed by the Quality Improvement Organization
(QIO) program, under contract to CMS. A QIO is present in each U.S. state,
territory, and the District of Columbia.” The first modules of DOQ-IT U focus on physician office workflow redesign,
culture change, and communication necessary for successful HER adoption,
implementation of care management, and the incorporation of a strong
patient self-management component to clinical care. Disease specific
modules, starting with diabetes, will include a patient self-management
component. CMS says additional features, such as surveys, utilization
tracking, and Continuing Medical Education/Continuing Education Unit
(CME/CEU) offering and issuing capabilities will also be included in
the near future. A technical advisory panel will provide content, consultation and evaluation
of the care management/DOQ-IT U modules. The panel includes experts from
the American College of Physicians, American Academy of Family Physicians,
the American Board of Internal Medicine, the Healthcare Information and
Management Systems Society (HIMSS), private payers, the American Health
Information Management Association (AHIMA), and patient self management
experts. For more information, visit: http://elearning.qualitynet.org. The Centers for Medicare & Medicaid Services (CMS) recently issued
a proposed rule meant to improve the accuracy of Medicare’s payment
under the acute care hospital inpatient prospective payment system and
provides additional incentives for involvement in quality improvement
efforts. Comments on the proposed rule are due by June 12, 2007. The
final rule will affect discharges on or after October 1, 2007. CMS proposes to restructure the inpatient diagnosis related groups (DRGs)
to account more fully for the severity of the patient’s condition
(creating 745 new severity-adjusted diagnosis related groups (DRGs) to
replace the current 538 DRGs). In addition, the proposed rule includes
provisions to ensure that Medicare no longer pays hospitals for additional
costs associated with hospital-acquired conditions (including infections). The proposed rule would also add five new quality measures, which would
bring to 32 the number of measures hospitals report in FY 2008 in order
to qualify for the full market basket update in FY 2009. The five proposed
measures include: Among other things, the proposed rule would: Medicare’s inpatient rates for operating expenses will increase
by 3.3 percent in FY 2008 for those hospitals that report quality data
to CMS. Overall, the proposed rule is estimated to increase payments
to more than 3,500 acute care hospitals by $3.3 billion. “The payment reforms included in this proposed rule would continue
a process for the third consecutive year to ensure that Medicare payments
for inpatient services are more accurate and better reflect the severity
of the patient’s condition,” said CMS Acting Administrator
Leslie V. Norwalk, Esq. “The proposed rule also represents yet
another major step forward in Medicare’s efforts to foster higher
quality care in inpatient settings.” Read the proposed rule at: http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1533-P.pdf The Agency for Healthcare Research and Quality will host a free Webcast
on May 8 from 1:30 to 3:00 p.m. Eastern to launch the new CAHPS Clinician & Group
Survey. The survey, developed by the CAHPS Consortium, is designed to
provide a standardized measure of patient experiences with physicians
and medical groups. The results will be publicly reported. There are three survey instruments focusing on adult primary care, pediatric
primary care, and adult specialty care. Some of the topics covered in
the adult primary care survey include: wait time for urgent care, after
hours email, being kept informed about appointment start, health improvement,
health promotion and education, provider communication, provider knowledge
of specialist care, help with problems and concerns, and cost of care.
More details on the survey, including PDF versions, are available at:
https://www.cahps.ahrq.gov/content/products/CG/PROD_CG_CG40Products.asp The Webcast provides an opportunity for stakeholders and those wishing
to use the survey to ask questions. Presenters include: Charles Darby,
Co-Project Officer, CAHPS, AHRQ; Julie Brown, RAND Corporation Team;
Kristin Carman, American Institutes for Research (AIR) Team; and Dale
Shaller (Shaller Consulting) Harvard Team; Managing Director, National
CAHPS Benchmarking Database. Slides will be available on the AHRQ Web
site or about May 2. Questions can be submitted in advance by emailing:
cahps1@ahrq.gov. To register for the event, visit: Case Studies HHS Secretary Michael Leavitt recently issued a statutorily required
report to Congress on results of an e-prescribing pilot project. The
project to evaluate several e-prescribing standards was required by the
Medicare Modernization Act of 2003 (MMA). In the MMA, Congress set a
timetable for the Secretary to facilitate use of e-prescribing under
the new Medicare drug benefit, to help cut both medication errors and
health care costs. Five pilot sites were chosen to test the initial standards to determine
if they were ready for widespread adoption. Ohio KePRO, the QIO for Ohio,
joined University Hospitals Health System as one pilot site studying
the implementation of the standards in 300 primary and specialty care
physician offices. Overall, the pilot project demonstrated that three initial standards
are already “capable of supporting e-prescribing transactions” in
Medicare Part D: patients’ formulary and benefit information, medication
history, and the fill status of their medications. The project also found
that, with some adjustments, e-prescribing can work successfully in long-term
care settings. Some of the initial e-prescribing standards tested by the pilot project
were found to have potential but still need further development if they
are to be adopted as standards. These include standards used to convey
structured patient instructions, a terminology to describe clinical drugs,
and messages that convey prior authorization information. “Electronic prescribing improves efficiencies while helping to
eliminate potentially harmful drug interactions and other medication
problems,” Secretary Leavitt said. “It also solves the problem
of hard-to-read handwritten prescriptions.” Copies of the report to Congress and related materials are available
on the AHRQ Web site at: http://healthit.ahrq.gov/erxpilots. CMS recently announced the availability of $30 million in grant funds
for State Health Insurance Assistance Programs (SHIP) to provide personalized,
local insurance counseling the Medicare beneficiaries. As part of the SHIPs’ counseling responsibilities related to Medicare
benefits, SHIPs will now be instructed to inform Medicare beneficiaries
about the program’s screening and prevention benefits, including
those recently added by Congress (e.g., Welcome to Medicare Visit, cardiovascular
screening, diabetes screening, colorectal cancer screening). SHIPs have
noted that there appears to be no additional funding for this added responsibility. There is a SHIP in every state and U. S. territory to educate beneficiaries
about health insurance coverage, including Medigap, Medicare Advantage
options, Medicare prescription drug coverage, and long-term care financing.
SHIP counselors also provide information to Medicare beneficiaries about
new preventive health screenings and services. “CMS continues to value the important role that SHIPs play in
educating beneficiaries about Medicare,” said CMS Acting Administrator
Leslie V. Norwalk. “We have more than doubled our funding to SHIPs
since 2003 and look forward to working with these programs and other
community-based organizations to continue to support Medicare beneficiaries.” “With these 2007 grant awards, SHIPs are expected to continue
to achieve measurable accomplishments that support beneficiaries in local
communities,” she continued. SHIP grants are calculated in two parts.
The initial grant is distributed as a fixed award of $75,000 ($25,000
to Guam and the Virgin Islands) to each applicant. The second portion
is a variable sum based on the percentage of nationwide Medicare beneficiaries
who live in the state, the proportion of the state’s Medicare beneficiaries to the total
state population, and the proportion of the state’s Medicare beneficiary
population who live in rural areas. For more information or to apply for a SHIP grant, visit www.shiptalk.org. HHS Secretary Mike Leavitt announced this week that Robert M. Kolodner,
MD, will permanently lead the Office of the National Coordinator for
Health Information Technology (ONC). Dr. Kolodner has been serving as
the Interim National Coordinator for Health IT since Sept. 20, 2006.
The appointment is effective immediately. Dr. Kolodner joined HHS from the Department of Veterans Affairs’ (VA)
Veterans Health Administration (VHA), where he was Chief Health Informatics
Officer. In that role, he was chief advisor to the VA’s Under Secretary
for Health on information technology issues and oversaw the development
of the VA’s renowned electronic healthrecord, VistA. Dr. Kolodner’s
long-standing interest in computers and his training as a psychiatrist
led to his early involvement with VA’s efforts to use automation
in support of mental health care and subsequently his leadership in coordinating
clinical record access across al clinical disciplines. In his role as head of ONC, Dr. Kolodner will advise Secretary Leavitt
on all health IT initiatives and continue to develop, maintain, and direct
the implementation of the strategic plan to guide nationwide adoption
of interoperable health IT. Critical Access Hospital Fact Sheet The Centers for Medicare & Medicaid Services Recently released
a new version of the Critical Access Hospital Fact Sheet. The sheet includes background information on CAHs, including criteria
that must be met to receive CAH designation, as well as explanations
of incentive payments and bonus opportunities. Also included are
changes in payment information effective as of January 1, 2007. Read the fact sheet at: www.cms.hhs.gov/MLNProducts/downloads/CritAccessHosp07fctsht.pdf. Researchers from IPRO, the New York QIO, recently teamed up with health
care consulting group, The Kuhmerker Consulting Group, LLC, to produce
the first nationwide survey of pay-for-performance (P4P) practices in
state Medicaid programs. The report was published this week by The Commonwealth
Fund. “Medicaid is a major source of funding of health care in every
state and, therefore, has a significant influence on the health care
system,” said Thomas Hartman, Vice President for Health Care Quality
Improvement for IPRO and co-author of the study. “But each state
operates its program independently of the others. We thought it would
be helpful to provide a detailed snapshot of what is taking place around
the nation so that state officials have solid information on which to
base decisions about pay-for-performance.” The report, “Physician Pay-for-Performance in Medicaid: A Guide
for States,” shows that more than half of all state Medicaid programs
provide financial incentives to health care providers for better quality
care and almost 85 percent of states plan to have P4P programs within
five years. The report also identified several trends: The authors also found that few Medicaid programs have formal evaluations
of their P4P programs. “Ultimately, the biggest challenge facing
both state Medicaid P4P programs, and those operated under other auspices,
is to determine their effectiveness,” the authors conclude. In an announcement about the report, The Commonwealth Fund said the
report “offers practical lessons from a variety of Medicaid, commercial,
and Medicare pay-for-performance programs.” Information for the report was gathered through a written survey sent
to all state Medicaid directors, follow-up interviews with the directors
and their staffs, and documents and Web-based resources on the programs.
The study was conducted from May through October 2006. Read the report
at: http://www.cmwf.org/publications/publications_show.htm?doc_id=472891 Media coverage of this report includes articles by the Associated Press,
United Press International and Health IT trade publications. May is Healthy Vision Month, a national eye health campaign devoted
to promoting the Vision objectives in Healthy People 2010. Healthy Vision
Month is sponsored by the National Eye Institute (NEI) and the National
Eye Health Education Program. Free materials are available to distribute
to physicians and health care providers. During each year’s observance month, the NEI and NEHEP promote
a vision objective from Healthy People 2010. In May 2007 the groups will
promote glaucoma aiming to educate not only those at risk of the disease
but also their loved ones about the importance of early detection and
treatment. Information on this year’s topic is available at: Free educational resources and materials include: Healthy Vision Month E-Mail Signature Line To order free materials, please visit: http://catalog.nei.nih.gov/productcart/pc/viewCat_L.asp?idCategory=31 In a March 28th, audio podcast from the Agency for Healthcare Research
and Quality (AHRQ), Peter Pronovost, M.D., Ph.D., of The Johns Hopkins
University School of Medicine in Baltimore, discussed his research about
interventions to reduce bloodstream infections in hospital ICUs caused
by central venous catheters. The 9-minute podcast is part of AHRQ’s
Healthcare 411 series. Users can listen to the audio program through
a computer or download it for playing in a portable audio device. For
details and downloading, visit: http://www.healthcare411.ahrq.gov/ The Certification Commission for Healthcare Information Technology (CCHIT)
recently announced a restructuring of its volunteer work groups as well
as plans to recruit additional staff to support development of a significantly
expanded certification program for 2008. Under the new structure, universal electronic health record (EHR) requirements
applicable to all settings will be addressed by a new EHR Foundation
work group. The current work groups addressing office-based (ambulatory)
and hospital-based (inpatient) criteria will continue to focus on the
requirements specific to those two settings, supplemented by a third
work group developing criteria for Emergency Department systems. Another
new group will be formed to begin developing certification criteria for
health information networks, the third phase of the Commission’s
contract with the U.S. Department of Health and Human Services. Besides those five work groups, there will be five new “expert
panels” that will concentrate on security, privacy, interoperability,
and the new expansion areas of children’s health care and cardiovascular
medicine. These changes allow volunteers two options to participation in the Commission – either
as a member of an expert panel to address specialized issues in depth
or in a work group. Town call scheduled Commission to recruit new staff  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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