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OIG Report Calls for Greater QIO Focus on
Transitions of Care Mortality Data Added to Hospital Compare;
QIOs Asked to Help Poor Performers HHS Launches Initiative to Improve the Health
of Hispanic Elders AHRQ Evidence Report on Care Coordination OMH Seeks Applicants for Demonstration Program GAO Releases Report; AHQA Issues Release Magazine Highlights Patient Safety Project
as Rural Success Story In a recent report, the Health and Human Services Office of Inspector
General called for greater involvement by QIOs in transitioning Medicare
beneficiaries between inpatient and skilled nursing facilities (SNF). The report, “Consecutive Medicare Stays Involving Inpatient and
Skilled Nursing Facilities” analyzed consecutive stays that include
at least one inpatient stay and one SNF stay in 2004. After stratifying
the stay sequences into low, medium, and high payment categories, the
OIG found: The report recommends that: “These recommendations support what we believe is a CMS priority
for QIOs in the 9 th Scope of Work,” said David Schulke, AHQA Executive
Vice President. “Numerous research studies point to care transitions
as a weak point in the health care system – this study shows that
the weakness is also extremely costly. Utilizing QIOs to monitor and
improve this area is an excellent idea.” CMS’ comments on the report were not publicly available but OIG
paraphrased the response saying that: Read the report at: http://oig.hhs.gov/oei/reports/oei-07-06-00340.pdf On June 21, the Centers for Medicare & Medicaid Services (CMS),
added hospital mortality data to the Hospital Compare consumer Web site
(www.hospitalcompare.hhs.gov).
QIOs have been asked to help those hospitals with higher than expected
death rates improve. The two 30-day hospital mortality outcome measures include care
for patients with heart failure and heart attack for more than 4,500
hospitals across the country. The risk-adjusted measures are based on
hospital admissions that occurred between July 1, 2005, and June 30,
2006. The process of care measures on Hospital Compare are updated quarterly
but the mortality measures will be updated annually. In a press release, CMS identified resources for hospitals that need
to improve their mortality rates, saying “In addition to technical
assistance available by the agency’s Quality Improvement Organization
Program, which works directly with hospitals to improve care processes,
organizations such as the American Heart Association and American College
of Cardiology have technical resources for hospitals targeting cardiovascular
care.” “We are proud that Medicare officials have turned to the QIOs
to address this very serious problem,” said David Schulke, Executive
Vice President of the American Health Quality Association (AHQA). CMS
has instructed QIOs to help these low-performing hospitals through a
three-step approach: Not every QIO will participate in this additional work. Twenty-one QIOs
have at least one hospital on the low-performing list in their state.
CMS has already instructed these QIOs to begin work. AHQA supports the expansion of QIO efforts to improve quality in low-performing
hospitals, nursing homes, and other settings of care. “This is
a logical expansion of QIO work. QIOs have a good track record of achieving
improvements with low-performing nursing homes,” Schulke said, “giving
troubled providers access to the QIO resource makes good sense.” “In addition to providing helpful information to beneficiaries,
measuring and reporting on mortality also provides hospitals with the
information they need to analyze and improve performance,” CMS
Acting Administrator Leslie V. Norwalk said. “All hospitals will
get detailed reports from CMS for use in quality improvement. These
reports serve as a tool to help hospitals look more broadly at their
outcomes and processes of care and identify ways to lower mortality risk
for their patients.” Concurrent with the addition of mortality measures, CMS also unveiled
the first annual update of pricing and volume information on certain
elective hospital procedures, which can be found online at www.cms.hhs.gov/HealthCareConInit/02_Hospital.asp#TopOfPage. HHS Secretary Michael Leavitt recently announced a new national initiative
to encourage Hispanic elders and their families to take advantage of
new Medicare benefits, including prescription drug coverage, flu shots,
diabetes screening and self-management, cardiovascular screening, cancer
screening services and smoking cessation programs. “Improving Hispanic Elders’ Health: Community Partnerships
for Evidence-Based Solutions,” will be piloted in up to seven metropolitan
areas with large Hispanic elder populations: Chicago, Illinois; El Paso,
Texas; Houston, Texas; Los Angeles, California; McAllen, Texas; Miami,
Florida; New York, New York; San Antonio, Texas; and San Diego, California.
Teams comprised of representatives from local public health providers,
Hispanic community organizations, aging service providers and the health
care sector will convene in each area to learn about state-of-the-art
strategies and tactics to address disparities among their Hispanic elder
populations. The Initiative will also help Hispanic elders take advantage
of a Chronic Disease Self-Management Program developed by Stanford University
with funding from HHS that has proven effective in reducing the risk
of chronic disease and disability among Hispanic elders. Findings from the 2006 National Healthcare Disparities Report prepared
by the Agency for Healthcare Research and Quality (AHRQ) show that persistent
and growing health disparities exist among Hispanic elders compared to
the non-Hispanic white elderly population. To address this issue, AHRQ,
the Administration on Aging, the Centers for Disease Control and Prevention,
the Centers for Medicare & Medicare Services and the Health Resources
and Services Administration are teaming up with this Initiative to assist
local communities in developing more coordinated strategies for improving
the health and well-being of Hispanic elders. “This unprecedented partnership will make it easier for communities
to help Hispanic elders, especially those with chronic health conditions
and limited resources, to overcome barriers that impede their access
to healthcare and social supports that can improve their health,” Secretary
Leavitt said. The deadline for applications is Tuesday, July 24, 2007. While any member
of the proposed teams may serve as the lead, the local Area Agencies
on Aging are being asked to submit the application. For more details
about “Improving Hispanic Elders’ Health: Community Partnerships
for Evidence-Based Solutions,” visit http://www.academyhealth.org/ahrq/elders. The Agency for Healthcare Research and Quality (AHRQ) recently released
a new evidence report, “Closing the Quality Gap: A Critical Analysis
of Quality Improvement Strategies” that shows how care coordination
strategies involving family members, case managers, physicians and other
clinicians improve patient outcomes. The strongest evidence shows benefit of care coordination interventions
for patients who have congestive heart failure, diabetes mellitus, severe
mental illness, a recent stroke, or depression, though evidence about
key intervention components is lacking. Little evidence is available
to evaluate the effect and cost of care coordination strategies, including
managed care and publicly funded programs, such as Medicaid. The report was prepared by AHRQ’s Stanford University Evidence-based
Practice Center. The report is available at: Care Coordination, Quality
Improvement http://www.ahrq.gov/clinic/tp/caregaptp.htm and
a companion white paper, “Children With Special Health Care Needs,
Care Coordination Strategies” is available at: http://www.ahrq.gov/clinic/tp/cshcntp.htm Print
copies of the report and white paper are available by sending an e-mail
to ahrqpubs@ahrq.hhs.gov. The Office of Minority Health (OMH) announced the availability of $2.3
million to help reduce disparity among minority populations with low
English proficiency (LEP) in the June 28 Federal Register. Applications
must be submitted by July 30, 2007. The Bilingual/Bicultural Demonstration Grant Program is intended to
improve the health status of LEP populations by eliminating disparities.
The grant program is intended to “ascertain the effectiveness of
partnerships between community-based, minority serving organizations
and health care facilities in addressing: cultural and linguistic barriers
to effective health care service delivery; and access to quality and
comprehensive health care for LEP populations, particularly racial and
ethnic minorities, living in the United States.” OMH anticipates awarding 12 to15 grants ranging from $150,000 to $175,000
per year. The program’s start date is September 1, 2007 and will
run for three years (until August 2010). Read the Federal Register announcement
at: http://frwebgate5.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=141189219824+0+0+0&WAISaction=retrieve The Government Accountability Office (GAO) recently released its report
on QIO work in nursing homes. AHQA issued the following press release: For Immediate Release June 29, 2007 GAO Recommends Adding Low Performing Nursing Homes to QIO Work
and Strengthening Quality Measurement Two-thirds of nursing homes say voluntary partnerships with
QIOs Washington, DC– A
report released today the Government Accountability Office (GAO) recommends
that the Centers for Medicare & Medicaid Services (CMS) expand the
Quality Improvement Organization (QIO) program work to include a larger
number of “low-performing” nursing homes. GAO also suggests
that CMS develop a plan to continuously update the quality measures used
to evaluate nursing home improvement. The report, “Nursing Homes: Federal Actions Needed to Improve
Targeting and Evaluation of Assistance by Quality Improvement Organizations,” calls
for CMS to strengthen the QIO nursing home improvement initiative by
securing agency access to nursing home level data, increasing evaluation
of QIO effectiveness in greater detail so the most effective QIO interventions
can be broadly adopted, and focusing more QIO assistance on low-performing
nursing homes. “GAO is calling for expanding QIO work to help more struggling
nursing homes, and we think that is a great idea. In fact, every QIO
began working with low-performing nursing homes on a small scale in 2005.
The problem is not a lack of willingness or skill, we have that. The
key to scaling up is funding,” said David Schulke, Executive Vice
President of the American Health Quality Association (AHQA), which represents
QIOs. “This GAO report is the second federal study this week to
recommend new nursing home work by QIOs. On Monday, the HHS OIG recommended
that QIOs begin examining care transitions as patients move from hospitals
into nursing homes [http://oig.hhs.gov/oei/reports/oei-07-06-00340.pdf].
It will be up to Congress to decide whether QIOs can offer more service,
particularly much more costly service in low-performing nursing homes,
because funding for QIO quality improvement work is now below the 2002
level,” Schulke added. History of Success Since August 2005 QIOs have worked with 145 nursing homes identified
by state regulators as low performers due to quality deficiencies. Data
from the last quarter of 2006 indicate that these homes achieved a 15
percent relative improvement on pressure ulcer care and a 37 percent
relative improvement in the use of physical restraints – better
than the national average rate of improvement for all nursing homes,
which was 9 and 21 percent, respectively (see attached chart). GAO interviewed staff from thirty-two nursing homes selected for a variety
of geographic and other characteristics. Two-thirds reported that QIO
assistance helped them to improve; thirteen percent said it made no difference. “The
fact that busy nursing home staff worked voluntarily with QIOs for over
two years strongly suggests that the relationship has value. The staff
at most facilities confirm the QIOs have helped them improve,” Schulke
said. Strengthened Quality Measurement Process Needed The GAO report was requested by Senator Charles Grassley (R-IA). The
report is available at: http://www.gao.gov/new.items/d07373.pdf.
The Health and Human Services Office of Inspector General (OIG) report, “Consecutive
Medicare Stays Involving Inpatient and Skilled Nursing Facilities,” was
released on June 25; it is available at: http://oig.hhs.gov/oei/reports/oei-07-06-00340.pdf An article about the West Virginia Medical Institute’s (WVMI’s)
patient safety project appeared in a February publication of the National
Rural Health Association, What Makes Rural Health Care Work?: An NRHA
American Tour. The article, “ West Virginia: Quality Improvement Organization – Partner
for Safety,” shows how WVMI and a host of partners used technology
to improve rural care for the entire state. West Virginia is a national leader in patient safety, according to
WVMI’s Chief Executive Officer John Wiesendanger. “Being
included in this publication is a testament to the hard work and commitment
to quality demonstrated by our rural hospitals,” he said. West Virginia was one of 13 states profiled in the 33-page glossy black-and-white
publication, which is a special edition of the Journal of Rural Health.
The stories highlight “exemplary” rural programs that other
states can adopt to improve the health of its citizens, according to
the introduction. WVMI Patient Safety Director Patricia Ruddick said the project owes
its success to the dedication of its many partners, which include 28
rural hospitals, along with the West Virginia Hospital Association, the
West Virginia Office of Rural Health, Verizon communications and Quantros
Inc., a California company that develops software for health care providers. “We’ve
seen a lot of progress in quality improvement and patient safety through
working with our hospitals and grant partners,” said Ruddick. WVMI implemented the patient safety project in 2001 after the Institute
of Medicine released the landmark report, To Err is Human. WVMI and its
partners in 2004 received a $1.7 million matching federal grant from
the Agency for Healthcare Research and Quality to expand the project,
which is in its third year of funding. As part of the project, hospitals
voluntarily provide WVMI with data on medical errors. They have reported
more than 40,000 events. The 15,000-member rural health association is a national nonprofit organization
that provides leadership on rural health issues, according to its Web
site.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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