Quality Update for September 7, 2007

New Dementia Care Practice Recommendations Released CMS No-Payment Rule Is Final Weems Named Action Administrator for CMS HHS Makes Additional $75 Million Available for Pandemic Preparedness Drop in Article for LIS Available Quality Organization Brings Wristband Project to Colorado Large Practice Groups Successfully Improve in CMS Demo Project AHRQ PodCast Focuses on Hand Washing MyMedicare Sends Reminders New Dementia Care Practice Recommendations Released The Alzheimer’s Association recently released its third set of Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes. The Recommendations, which capture the consensus of more than 30 national care organizations, focus on improving the end of life experience for people with Alzheimer’s and other dementias. More than 50 percent of residents in assisted living and nursing homes have some form of dementia or cognitive impairment (including Alzheimer’s) and about 67 percent of dementia-related deaths occur in nursing homes. “Our highly collaborative, consensus-based process ensures that the Recommendations represent the best dementia care practices and, at the same time, are practical so that nursing homes and assisted living residences can incorporate them into the daily care routines of their residents,” said Jane Tilly, DrPH, Director of Quality Care Advocacy for the Alzheimer’s Association. The Recommendations emphasize the importance of consistency in individualized and person-centered care approaches; development of relationships between staff and residents; and increasing staff knowledge of individual resident needs, abilities, and preferences. They are available at: http://www.alz.org/documents/DCPRPhase3_.pdf According to the authors, one key finding is the need to start advance planning for end of life care as soon as possible after the diagnosis of dementia. This includes documenting a person’s wishes regarding medical treatments in advanced stages of dementia and designation of a proxy decision-maker – actions that will likely become even more critical as the Baby Boomer generation ages and the number of people at the age of highest risk for dementia increases. Two primary sources were used to develop the Recommendations: “End-of-life Care for People with Dementia in Residential Care Settings,” a literature review by Ladislav Volicer, MD, PhD, that summarizes current research relevant to end-of-life care for residents with severe dementia and “Quality End-of-life Care for Individuals with Dementia in Assisted Living and Nursing Homes and Public Policy Barriers to Delivering This Care,” by Dr. Tilly, with Abel Fok, which describes high quality end-of-life care for residents with dementia. The literature review is available at: http://www.alz.org/national/documents/endoflifelitreview.pdf Development is also underway for classroom-style and online training programs based on the Recommendations for all levels of care staff in assisted living residences and nursing homes. The Alzheimer’s Association is also working with providers and federal and state policy makers to incorporate the Recommendations into quality assurance systems. The Recommendations are part of the Alzheimer’s Association’s Quality Care Campaign, which began in 2005. The end of life Recommendations represent Phase 3 of the project; Phase 1 focused on the basics of good dementia care while Phase 2 focused on wandering, falls and physical restraints. Back to top CMS No-Payment Rule Is Final In the May 3 Federal Register, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would eliminate hospital reimbursement for a select group of preventable complications. That rule is now final. Medicare will no longer pay hospitals to treat the following eight complications of underlying conditions if they occur in the hospital: injuries from patient falls, pressure ulcers, urinary-tract infections, vascular-catheter-associated infections and mediastinitis, objects left in the body during surgery, air embolisms, and blood incompatibility. The list takes effect in October 2008; news reports say Medicare will add three more conditions to the no-payment list next year. The new rule was mandated under Section 5001(c) of Public Law 109-171 (the Deficit Reduction Act of 2005), which requires the Secretary of the Department of Health and Human Services to select by October 1, 2007, at least two hospital-acquired medical conditions for which hospitals will not be paid. “Congress has thrown down a gauntlet by instructing CMS to refine the hospital payment system in a way that penalizes poor outcomes,” said David Schulke, AHQA Executive Vice President. Back to top Weems Named Action Administrator for CMS President Bush recently appointed Kerry Weems as Acting Administrator for the Centers for Medicare & Medicaid Services. Weems was nominated as Administrator by the President in May but the Senate has yet to schedule a confirmation vote to make the position permanent. “Though his nomination is currently pending in the Senate, it is important that we have solid leadership in place now with the authority to head this critical agency,” said HHS Secretary Michael Leavitt in a statement. “Kerry has served this Department for nearly a quarter-century, undertaking many challenges in managing large budget and organizations, and showing success at every turn.” As Acting Administrator, Weems will immediately assume the responsibilities of the position vacated by Leslie Norwalk in July. Norwalk served as Acting Administrator following the departure of Mark McClellan, MD, PhD, last October. According to news reports about his confirmation hearing in late July, Weems declared that if he were confirmed he would “intensify CMS oversight.” Back to top HHS Makes Additional $75 Million Available for Pandemic Preparedness HHS Secretary Mike Leavitt announced at the end of August that an additional $75 million in funding would be made available to states, territories, and four metropolitan areas to strengthen the capacity to respond to a pandemic influenza outbreak. The one-time pandemic influenza response planning grants will supplement the $430 million HHS announced on June 28, 2007, to strengthen the ability of hospitals and other health care facilities to respond to bioterror attacks, infectious diseases, and natural disasters that may cause mass casualties. The supplemental funding will be used to: stockpile critical medical equipment and supplies; continue development of plans for maintenance, distribution and sharing of those resources; plan for and develop pandemic alternate care sites; and conduct medical surge exercises. More information on state and local funding allocations is available at http://www.pandemicflu.gov/news/allocation.html. More information on pandemic flu preparedness efforts is online at www.pandemicflu.gov. Back to top Drop in Article for LIS Available The Centers for Medicare & Medicaid Services (CMS) recently distributed a drop-in article to help partners educate beneficiaries who might be eligible for extra help in paying for their prescription drugs. CMS asks partners to use the article in publications or outreach efforts that might reach low income beneficiaries. Medicare beneficiaries who believe they may be eligible should contact Social Security to apply for the low-income subsidy, the article explains. Beneficiaries are eligible for the subsidy all year long, not just during the open enrollment period. For a copy of the drop in article, contact Barbara Cebuhar, Office of External Affairs, Provider Relations Group at 202-260-1020. Back to top Quality Organization Brings Wristband Project to Colorado The Colorado Foundation for Medical Care (CFMC), in partnership with the Colorado Hospital Association (CHA), recently released a customized wristband toolkit to all hospital quality directors and CEOs in Colorado. The release is part of a regional movement initiated by the Western Alliance for Patient Safety (WRAPS) to standardize wristband colors in all health care facilities to improve patient safety. CFMC and CHA formed a workgroup to develop appropriate standards for Colorado and secure hospital participation. Standardized wristband colors make it easier for health care workers, particularly those who work in more than one facility, to more readily recognize “at risk” patients. Colorado’s customized toolkit was based on the kit released by Arizona earlier in the year. The toolkit is available on CFMC’s Web site at http://www.cfmc.org/hospital/hospital_wristbands.htm. To date, 12 states across the country have adopted the standardization and another six are considering it. Back to top Large Practice Groups Successfully Improve in CMS Demo Project All physician groups participating in a demonstration project to improve chronic care showed improvement on the clinical management of care for diabetes patients, the Centers for Medicare & Medicaid Services recently reported. These improvements represent efforts of the first year of a three-year project that links payment with improved care. The Medicare Physician Group Practice (PGP) Demonstration, which began on April 1, 2005 and is implemented by RTI International, rewards providers for coordinating and managing the overall health care needs of Medicare patients with chronic conditions. While providers are paid as usual through the fee-for-service system, they also have an opportunity to share in the savings generated by improved care. The PGP demo includes physician groups, integrated delivery systems, and other organizations with 150 or more full time physicians; ten practice groups are participating. Each group is working on 32 quality measures that are a subset of those developed for CMS’ Doctors Office Quality (DOQ) Project. They started with diabetes measures: HbA1c testing and control; blood pressure control; lipid testing and LDL cholesterol control; urine protein testing; eye and foot exams; and influenza and pneumonia vaccination. In year two, measures for congestive heart failure and coronary artery disease were added; and, in year three, participants are focusing on hypertension and preventive care (cancer screening). At this time, CMS is reporting on the results of the first year’s effort. In a 2006 report to Congress on the project, Health and Human Services Secretary Michael Leavitt enumerated the main strategies being used by participants to improve performance: “(1) provider education and feedback including data profile reports comparing individual providers to their peers or other benchmarks; (2) better adherence to quality of care protocols on the part of both patients and physicians through disease management interventions; and (3) implementation of standardized, evidence-based care models and protocols.” In addition, Secretary Leavitt told Congress that participants are “making major efforts to promote knowledge of and adherence to standardized, evidence-based “best practice” models among their physicians through redesigning workflow processes, adding health-maintenance modules to existing electronic medical records, and developing patient registries with the ability to provide reminders and prompt physicians to provide or act on information at the point of care.” Some examples of new care processes utilized by participating groups include: Making lab results for diabetic patients available to physicians prior to patient encounters, preparing patients in advance for foot exams, educating patients about the importance of self-care techniques and their disease, and following-up with them in between visits. Dartmouth-Hitchcock Clinic is educating patients about their medical condition, which leads to more productive clinical encounters. The Everett Clinic is requiring a post-discharge physician follow-up visit within ten days to address any unsolved or new health care problems and has partnered with local providers to place palliative care nurses in their clinics to work directly with physicians to improve end of life care. St. John’s Health System is using a web-based patient registry that assists physicians in planning patient encounters. Forsyth Medical Group is making clinical staff more aware of the needs of patients with chronic diseases. In addition, Billings Clinic, Geisinger Clinic, Marshfield Clinic, Middlesex Health System, and Park Nicollet Health Services, have implemented new care management programs for patients with congestive heart failure that are designed to identify changes in symptoms of heart failure early on and arrange for timely and appropriate follow-up. According to year-one results, all participating physician groups - Billings Clinic, Everett Clinic, Dartmouth-Hitchcock Clinic, Forsyth Medical Group, Geisinger Clinic, Middlesex Health System, Marshfield Clinic, Park Nicollet Health Services, St. John’s Health System, and the University of Michigan Faculty Group Practice - achieved benchmark or target performance on at least seven of the ten diabetes clinical quality measures. Two physician groups -- Forsyth Medical Group and St. John’s Health System – met all ten benchmarks. Marshfield Clinic and University of Michigan Faculty Group Practice – earned performance payments for quality and efficiency of $7.3 million -- their share of the $9.5 million in savings to the Medicare program. Physician groups are measured on performance using all health care spending for patients assigned to the group in relation to a comparison population of Medicare patients from their local market area. A total of 223,893 Medicare patients were assigned to the ten physician groups in performance year 1 which ended March 2006. “This demonstration project provides new evidence that paying for quality of care instead of volume of services helps the program, physicians and patients,” said Secretary Mike Leavitt. More information on the PGP demo is available at: http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType= none&filterByDID=0&sortByDID=3&sortOrder=ascending&itemID=CMS1198992&intNumPerPage=10 Back to top AHRQ PodCast Focuses on Hand Washing The Agency for Healthcare Research and Quality recently released a Healthcare 411 podcast focusing on the importance of hand washing in health care settings. Last year, AHRQ Director Carolyn Clancy, MD signed a World Health Organization pledge committing the United States to support a campaign called “Clean Care is Safer Care.” The US joined 21 other countries to support the effort that promotes hand washing and other methods of reducing health care associated infections. As part of the Campaign, WHO recently unveiled a 9-item checklist to help prevent infections and other health care errors. In the podcast recording, Dr. Clancy says that no patient who enters the health care system expects to “emerge with another problem namely an infection” that was acquired in the hospital. “This is a big, big problem in this country and it turns out it’s a big problem in many other countries as well,” Dr. Clancy added. “So we know it’s a global challenge, and we thought that by working with our partners around the world, we could make more significant progress than we’ve been able to make to date.” Dr. Clancy also explains why hand washing is so important and the difficulty in reaching 100 percent compliance with a seemingly simple step that can prevent unwanted infections. She also suggests that patients and family members help providers remember that hand washing is important, “it is very possible to say something like, ‘You know, I’ve read that hand washing is really important and that some times doctors, nurses - fill in the blank - are too busy to remember. Have you washed your hands?’” The audio program, which routinely features experts discussing contemporary health care issues is available online at: http://www.healthcare411.ahrq.gov/podcast.aspx?id=212 Back to top MyMedicare Sends Reminders A new functionality was recently added to the Centers for Medicare & Medicaid Web site, MyMedicare.gov, which is designed to help beneficiaries track their preventive services eligibility and utilization. The new feature allows CMS to send those beneficiaries who provide an email address a reminder to let them know they are eligible for a preventive service. CMS has developed a brochure, available in Spanish and English, to provide information about signing up for mymedicare.gov. “Step by Step Instructions for Using Mymedicare.gov” is available in English at: http://www.medicare.gov/Publications/Pubs/pdf/11297.pdf and in Spanish at: http://www.medicare.gov/Publications/Pubs/pdf/11297_S.pdf Looking for a job in quality? Searching for a quality improvement expert? Visit the AHQA Job Board at www.ahqa.org. Back to top

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