   |
|
|
|
JCAHO Changes Timing of Antibiotics for Pneumonia CMS
Issues Guidance on Requirements for Hospital Emergency Services U.S.
Joins International Effort to Standardize Medical Terminology Proposed
Rule Adds Quality Measures to HH Reporting, Refines Payment System HHS
Establishes New Office to Manage Public Health Emergencies Statistical
Brief Details ADEs in Hospitals AHRQ Vacancy Announcements Posted Report: Early Lessons on High-Performance
Networks The April 25th JAMA article, “JCAHO Tweaks Emergency Departments’ Pneumonia
Treatment Standards,” discusses changes to the timing of antibiotic
administration for patients diagnosed with community acquired pneumonia.
The change took effect in April. Previously, patients diagnosed with pneumonia were to receive antibiotic
administration within four hours of presentation. Now, the JCAHO standards
call for antibiotic administration within six hours. The four-hour time
frame did not reflect real world capabilities, even for high performing
hospitals, said experts. Physicians also expressed concern that the tight
time requirements could be leading to inappropriate antibiotic administration. In addition to changes in timing, JCAHO will also now allow physicians
to use a new data element, “diagnostic uncertainty,” if the
patients’ diagnosis of pneumonia was not clear at arrival. Cases
reflecting this data element will not be included in determining adherence
to antibiotic timing standards. Dale Bratzler, DO, MPH, Medical Director at the Oklahoma Foundation
for Medical, the state’s QIO, told JAMA readers that timing is
an important measure of quality and also serves as a catalyst for change
in the way hospitals process patients. “Many hospitals have addressed
systems of care to improve patient flow in the emergency department and
have focused on reducing unnecessary waiting for diagnostic tests and
treatment,” said Bratzler. “We do know that hospitals have
gradually improved performance on this measure and have often done so
by reducing unnecessary delays in the systems of care.” The article is available at: http://jama.ama-assn.org/content/vol297/issue16/index.dtl The Centers for Medicare & Medicaid Services recently issued guidance
to hospitals on emergency services requirements under the agency’s
Conditions of Participation (CoP), minimum standards which all hospitals
must meet in order to quality for Medicare payments. The guidance does
not apply to critical access hospitals (CAHs), which are subject to separate
regulation. The April 26 announcement in a Survey and Certification letter reiterates
Medicare’s long-standing requirement that nearly all hospitals
including specialty hospitals and others without emergency departments
-- have appropriate policies and procedures in place to address individuals’ emergency
care needs 24 hours per day, 7 days per week. Three key requirements
of the CoP are: capability to appraise the emergency situation, provide
initial treatment, and refer when appropriate. In announcing the policy,
CMS said that hospitals are not permitted to “to rely upon 9-1-1
services as a substitute for the hospital’s own ability to provide
these services.” “Any hospital participating in Medicare, regardless of the type
of hospital and apart from whether the hospital has an emergency department
must have the capability to provide basic emergency care interventions,” said
Leslie V. Norwalk, Esq., Acting Administrator of the Centers for Medicare & Medicaid
Services. “The guidance we are issuing today is part of an overall
strategy to ensure quality care by assuring the rapid response to emergencies
for all people with Medicare.” The CMS guidance follows an April 2 article in The New York Times titled, “Some
Hospitals Call 911 to Save Their Patients,” which detailed how
one hospital’s staff called 9-1-1 for emergency assistance when
a post-operative patient deteriorated and no physician was on site to
help. Read the Survey and Certification letter at: http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter07-19.pdf Health and Human Services (HHS) Secretary Mike Leavitt recently announced
that the United States is one of nine charter members of the new International
Health Terminology Standards Development Organisation (IHTSDO), an international
effort to encourage more rapid development and worldwide adoption of
standard clinical terminology for electronic health records. As a basis
for standard international terminology, IHTSDO (http://www.ihtsdo.org/members/)
acquired Systemized Nomenclature of Medicine Clinical Terms (SNOMED
CT) from the College of American Pathologists (CAP). SNOMED CT is a designated
U.S. standard in several interoperability specifications identified
by the Health Information Technology Standards Panel and has been available
free-of-charge to everyone in the U.S. since 2003 through the National
Library of Medicine (NLM). Under the new arrangement, the NLM (which serves as the U.S. member
of IHTSDO) will continue to distribute SNOMED CT through its Unified
Medical Language System, which incorporates, links, and distributes in
a common format more than 100 biomedical and health vocabularies and
classifications. The CAP will support IHTSDO operations through an initial
three-year contract and provide SNOMED-related products and services
as a licensee of the terminology. IHTSDO will assume responsibility for
the ongoing maintenance, development, quality assurance, and distribution
of SNOMED CT. “Current and potential U.S. users of SNOMED CT will gain some
immediate benefits under the new uniform international license terms
that will now govern use of SNOMED CT worldwide,” HHS National
Coordinator for Health Information Technology Robert Kolodner, MD, said. “A
single license will cover all types of use in both member and non-member
countries, with fees applying only to some types of distribution or use
in non-member countries.” “This use of a standard terminology will enable the use of health
information across borders, facilitate public health surveillance and
support evidence-based research,” said Secretary Leavitt. Other charter members of IHTSDO represent Australia, Canada, Denmark,
Lithuania, the Netherlands, New Zealand, Sweden, and the United Kingdom.
Membership is open to all countries. Details of the U.S. impact of the
change in ownership of SNOMED CT and information about obtaining access
to it may be found at: http://www.nlm.nih.gov/snomed The Centers for Medicare & Medicaid Services seeks to add measures
to data reporting requirements for home health agencies (HHAs) and continue
incentives for reporting in a new proposed rule. An official Notice of
Proposed Rule Making was published in the Federal Register on May 4,
2007. The comment period for this proposal will close on June 26, 2007. HHAs currently collect and report Outcome and Assessment Information
Set (OASIS) data to CMS and the agency proposes to continue using this
system to avoid placing any additional reporting burden or related costs
on providers. The proposed rule adds two new National Quality Forum-endorsed
measures to the 10 that are currently reported: emergent care for wound
infections - deteriorating wound status and improvement in status of
surgical wound. (HHA data on nationally accepted and approved quality
measures is publicly reported on Medicare’s Home Health Compare
Web site located at www.medicare.gov.) Under the proposed rule, HHAs that submit the required quality data
would receive payments based on the proposed full home health market
basket update of 2.9 percent for CY 2008. If a HHA does not submit quality
data, the home health market basket percentage increase would be reduced
by 2 percentage points to 0.9 percent for CY 2008. The proposed rule reflects the first refinements to the Medicare home
health prospective payment system (HH PPS) since 2000 and is estimated
to provide an additional $140 million in payments to home health agencies
in CY 2008, CMS said in a press release. Such refinements include changes
in episode payment and the case-mix regression model to more accurately
reflect the care provided. CMS posted the proposed rule in advance of Federal Register publication.
It is available at: http://www.cms.hhs.gov/HomeHealthPPS/downloads/CMS-1541-P.pdf.
A side-by-side fact sheet showing the differences between the current
HH PPS and CMS’ proposed refinements and updates is available at:
http://www.cms.hhs.gov/apps/media/fact_sheets.asp. Health and Human Services Secretary Leavitt has announced the establishment
of a new office to manage emergent public health threats. The Biomedical
Advanced Research and Development Authority (BARDA) will reside under
the HHS Assistant Secretary for Preparedness and Response and its director
will report to the Assistant Secretary. BARDA will provide an integrated, systematic approach to the development
and purchase of the necessary vaccines, drugs, therapies and diagnostic
tools for public health medical emergencies. BARDA will incorporate all
the programs, mission responsibilities and organizational functions previously
housed in the HHS Office of Public Health Emergency Medical Countermeasures,
which will be subsumed in the reorganization process. The establishment of this office will “help further the department’s
efforts to bridge the gap between the National Institutes of Health’s
research and development programs and Project BioShield,” said
Secretary Leavitt. Under a revised 8th Scope of Work contract, QIOs are to serve as public
health intermediaries to disseminate information and messages from CMS
to local entities in the event of a pandemic flu outbreak. AHRQ recently released a statistical brief from the Healthcare Cost
and Utilization Project titled, “Adverse Drug Events in U.S. Hospitals,
2004.” Highlights from the report include: Read the full
report at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb29.jsp AHRQ is seeking applicants for the positions of Director, Center for
Quality Improvement and Patient Safety (CQuIPS), and Director, Center
for Primary Care, Prevention, and Clinical Partnerships (CP3). CQuIPS
works to improve the quality and safety of our health care system through
evidence-based research, synthesis, and practical implementation of evidence-based
tools, products, strategies and interventions. CP3 expands the knowledge
base for clinicians, health care organizations and patients to assure
the translation of new knowledge and systems improvement into primary
care practices. The Center also supports and conducts research to improve
the access, effectiveness, and quality of primary and preventive health
care services by working closely with clinician groups and other primary
care-associated organizations to assure the implementation of that knowledge
into practice, the use of health information technology to improve health
care, and the evaluation/diffusion of effective health information technology
tools into clinical practice. Both announcements are on the www.usajobs.gov Web site. To read the
CQuIPS announcement, search for AHRQ-2007-0001; to read the CP3 announcement,
search for AHRQ-2007-0002. A recently released report by the Center for Studying Health System
Change (HSC) provides early lessons learned from 20 organizations in
the development of high-performance health networks. High-performance networks are an attempt by health plans to encourage
enrollees to choose physicians who score well on efficiency and quality
measures. The hope is that if these networks influence enough enrollees
to shift to higher-performing providers, physicians losing market share
might be motivated to improve efficiency and quality to better compete. The study, “Performance Health Plan Networks: Early Experiences,” shows
that physicians are generally skeptical of high-performance networks
and commonly complain of lack of communication from health plans. Physicians
also questioned the methodologies used to determine high-performance
designations and lack of standardization. Early lessons include: Communication with providers—Several plan executives noted the
importance of working with and educating physicians months in advance
of either going into a market or introducing a new product or initiative.
As one physician representative commented, “If you don’t
include your soldiers who deliver your care during the development and
vetting of the product, then you lose from the beginning.” Costs and quality both key—nearly all respondents said that the
success of high-performance networks is dependent on an assessment of
both costs and quality since high quality care can be delivered inefficiently.
Respondents all agreed that improved data are needed. Standardized industry measures—respondents discussed the need
for the industry to move toward more uniform standards of provider performance
measurement. One plan executive, for example, expressed concern that
physician quality determinations should not be based exclusively on data
one plan holds. He commented further that industry collaboration from
both the public and private sectors is needed to make informed decisions
about the quality of a practicing physician. Purchaser support—employers are often reticent about getting involved.
As one plan executive commented, “The most fascinating piece of
this is that the employer wants it, the health plan builds it, implements
it, and then the health plan gets the heat, and the employers who wanted
it duck and cover.” Read the report at: http://www.hschange.org/CONTENT/929/ The Certification Commission for Healthcare Information Technology (CCHIT)
recently certified 30 additional electronic health record (EHR) products
for office-based physicians. A total of 81 products have been certified
since the program began one year ago. All certified products are listed
on www.cchit.org. Mark Leavitt, MD, PhD, Certification Commission chairman commented on
the diversity of companies applying for certification, “A healthy
percentage of them are small – under $1 million in revenues – while
on the opposite end of the spectrum we see one of the country’s
largest organizations, the Department of Defense. There are commercial
as well as nonprofit entities, internally developed systems, even open
source software projects.” CCHIT began accepting applications for certification of ambulatory EHRs
under the 2007 criteria on May 1. Among a number of new requirements
this year, systems must be able to send prescriptions and refills to
pharmacies electronically and electronically receive standards-based
lab result messages. “This year’s new requirements go a long
way toward more complete interoperability of EHRs and health information
networks in the years ahead,” Certification Commission executive
director, Alisa Ray, said. Final criteria for 2007 ambulatory certification,
along with test scripts, a revised handbook, and contract agreement are
available at www.cchit.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
|
|
|
Copyright © 2003,
American Health Quality Association. All Rights Reserved. |