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OIG Releases a New Resource Guide on Corporate
Responsibility and Health Care Quality Journal Details QIO Work to Improve Medicare
Drug Therapy Court Requires HHS to Release Physician-Identified
Medicare Data; AMA Urges Appeal CMS Announces Plan for New Quality Data System HHS Issues Report on Personalized Health Care Judith A. Salerno Appointed as IOM Executive
Officer The Office of Inspector General (OIG) for the Department of Health
and Human Services (HHS) recently teamed up with the American Health
Lawyers Association to develop a resource guide for health care boards
of directors. The guide, “Corporate Responsibility and Health Care
Quality: A Resource for Health Care Boards of Directors,” is intended
to help boards understand the importance of overseeing the quality of
care provided by organizations for which they are responsible. By using
the resource to improve their knowledge base, directors will be able
to ask knowledgeable and appropriate questions related to health care
quality requirements, measurement tools, and reporting requirements. Health care boards face unique challenges, the guide says, because “promoting
quality of care and preserving patient safety are at the core of the
health care industry and the reputation of each health care organization.” The
national focus on health care quality measurement and reporting as well
as the emergence of quality as “an enforcement priority for health
care regulators” make the guidelines relevant and useful to boards
in exercising their oversight responsibilities and in supporting effective
corporate compliance as it relates to health care quality. The guide is divided into subsections that define the current health
care climate and explain board responsibilities related to each topic.
They include: A list of suggested questions that board members may wish to ask, followed
by an explanation of why each question is important, concludes the guide. The guide is the third in a series of documents on corporate responsibility
co-sponsored by OIG and the AHLA; prior publications discussed fiduciary
responsibilities. OIG will be hosting a series of roundtable discussions
with industry leaders, the first of which will focus on the boards’ role
in overseeing the quality of care provided in long-term care institutions.
The roundtable, currently scheduled for December 2007, will be co-sponsored
by the Health Care Compliance Association. The guide is available at: http://oig.hhs.gov/fraud/docs/complianceguidance/ A comprehensive report describing how QIOs are working in partnership
with Medicare Part D prescription drug plans (PDPs) and Medicare Advantage
plans (MA-PDs) to improve the quality of prescription drug therapy for
Medicare beneficiaries in the 8 th Scope of Work was published in a supplement
to the Journal of Managed Care Pharmacy late this summer. The supplement “Medicare Quality Improvement Organizations’ Ambulatory
Drug Therapy Improvement Activities and Partnerships with Medicare Part
D Prescription Drug Plans and Medicare Advantage Plans,” was authored
by AHQA Executive Vice President David Schulke and QIO experts Jim Grant
and Elaine Krantzberg from the Florida QIO, FMQAI. FMQAI holds the Physician
Practice/Pharmacy QIOSC contract. “According to the IOM, every year a half million adverse drug
events occur among ambulatory Medicare enrollees, including 180,000 life-threatening
or fatal events,” said Schulke. “The projects outlined in
this supplement have the potential to dramatically reduce those events,
but that potential is unlikely to be realized – at least in this
Scope of Work – because CMS is suddenly and retroactively taking
back the funding to support this work in the current contract.” Working with prescription drug plans to improve drug therapy is new
to the QIO program. Congress assigned the task as part of the Medicare
Modernization Act of 2003 (MMA), the same legislation that mandated the
prescription drug benefit. In part because CMS had little experience with quality improvement
and pharmacotherapy prior to passage of the MMA, QIOs were given latitude
to develop projects in partnership with physicians, pharmacists, and
plans. The results range from condition-focused Medication Therapy Management
(MTM) projects to academic detailing and implementation and use of ePrescribing
technology. “As this supplement shows, drug benefit plans and QIOs are cooperating
in very innovative projects to improve the quality of care for Medicare
beneficiaries,” said Judy Cahill, Executive Director of the Academy
of Managed Care Pharmacy , publisher of the journal. “Both managed
care pharmacy and beneficiaries are benefiting from this kind of assistance
to improve the therapeutic and financial value of the drug benefit.” The authors suggested that pharmacists use the supplement to understand
the “wide array of options” that are available when working
with QIOs and other partners on MTM and other quality improvement programs.
QIO recruited partners to work on these projects including managed care,
hospital, and community pharmacists; pharmacy associations; medical societies;
colleges of pharmacy; and long term care facilities. Some highlights
of the projects are below. One barrier QIOs encountered when implementing this work was the inability
to use data from different Medicare sources. As a work around, several
QIOs arranged to get medical and pharmacy data directly from health plans
to report quality performance and spur competition over quality performance. “When
given the ability to innovate like this, the QIO program is at its best,” said
Schulke. “This is the type of activity that is so critical to lead
transformation of our health care system. However, as IOM pointed out
in its report last year, stable priorities and stable funding are essential
for a more effective program.” Although the results of the projects will not be available until the
program is fully evaluated, the authors said, “QIOs and many Medicare
Part D plans have established promising partnerships and have begun to
share data for the purpose of assessing and improving plan and practitioner
performance as well as patient engagement.” Read the supplement at: http://amcp.org/data/jmcp/July%20B%20Supplement.pdf. According to a recent ruling by the U.S. District Court for the District
of Columbia, the Department of Health and Human Services must provide
physician-identified Medicare claims data to Consumers’ CHECKBOOK/Center
for the Study of Services, a non-profit consumer research and information
organization. The late August ruling requires HHS to release all the Medicare claims
data that CHECKBOOK/CSS sought for Illinois, Maryland, Washington, Virginia,
and Washington, DC. CHECKBOOK/CSS initially filed the suit in response
to HHS denials to its FOIA requests. HHS contended that the Freedom of
Information Act (FOIA) prevents the release of physician-identified data
for privacy reasons; the court disagreed. FOIA requests from CHECKBOOK/CSS
are now pending for data from the remaining states. The first use of the data will be to create a free resource on www.checkbook.org that
will report the number of various types of major procedures performed
by each physician and reimbursed by Medicare, “so a consumer selecting
a physician for a knee replacement or prostate surgery or other major
procedure will be able easily to check that a physician has an appropriate
level of experience,” said Robert Krughoff, president of CHECKBOOK/CSS,
in a press release announcing the ruling. CHECKBOOK/CSS is also expecting some of the nation’s leading health
plans, those with a strong consumer-information focus, to collaborate
with it, pooling their data with the Medicare data to create an even
more comprehensive procedure count for each physician. Other potential
uses of physician-identified Medicare claims data include measuring physicians
on how well they adhere to evidence-based care guidelines, said the CHECKBOOK/CSS
press release. The American Medical Association (AMA) recently sent a letter to Health
and Human Services Secretary Michael Leavitt urging the HHS to appeal
the decision declaring that the “risks and harm associated with
the release of this information far outweigh any potential benefits.” The
decision “poses a significant privacy risk to patients and physicians” and
could also undermine current transparency efforts wrote AMA Executive
Vice President and CEO Michael Maves, MD, MBA. Releasing the data would, “permit the unregulated, unqualified
distribution of sensitive health data to any person or entity without
regard to public interest, scientific integrity, or a demonstrated ability
to protect patient health information,” he wrote. Dr. Maves also
noted that the ruling allows use of the sensitive data by non-scientific
parties who “are not held to the rigorous standards against which
the best scientists and researchers in this country are held.” In a September 12th notice in the Federal Register, the Centers
for Medicare & Medicaid Services (CMS) announced its plans to use
data from the Performance Measurement and Reporting System (PMRS) to
provide physician-level information to consumers, online. The move would
allow consumers to compare quality and price among physicians and other
providers. The new system is scheduled to go into effect October 12. Characterizing the effort as “laying the foundation for pooling
and analyzing information about the quality of medical services and performance
provided by physicians and health care providers,” the agency said
it would work “in cooperation with” local and regional public/private
groups, including Chartered Value Exchanges. The PMRS will be a “master system of records” that will
support Secretary Leavitt’s transparency efforts by providing Medicare
beneficiaries cost and quality data needed to make informed decisions
about providers and practitioners. The Notice says that “CMS or
a non-Quality Improvement Organization (non-QIO) contractor would make
the individual physician-level performance measurement results available
to Medicare beneficiaries by posting it on a public Web site and by various
other methods of data dissemination.” The reference to “non-QIO” entities is due to statutory
and regulatory barriers to QIOs providing information publicly that identifies
a practitioner. At present, it is unclear where funding for PMRS effort
was obtained. According to the notice, CMS can provide PMRS data for the purposes
of: CMS can also provide PMRS data to support QIOs with claims review, studies
or other review activities, and beneficiary outreach activities. The
notice explains that “QIOs will work to implement quality improvement
programs, provide consultation to CMS, its contractors, and to state
agencies. QIOs will assist the state agencies in related monitoring and
enforcement efforts, assist CMS and intermediaries in program integrity
assessment, and prepare summary information for release to CMS.” For more details, read the notice at: http://a257.g.akamaitech.net/7/257/2422/01jan20071800/ The Agency for Healthcare Research and Quality released the 2005 National
Inpatient Sample (NIS) for the Healthcare Cost and Utilization Project
(HCUP) in July. The NIS is the largest all-payer database in the U.S., including data
on visits covered by Medicare, Medicaid, private insurance, and the uninsured.
The 2005 NIS contains all discharge data from 1,054 hospitals located
in 37 States. More than a 100 clinical and non-clinical elements are
captured from each hospital stay, including: For more information on, visit: http://www.hcup-us.ahrq.gov/nisoverview.jsp Health and Human Services Secretary Mike Leavitt released a report on
the department’s efforts to lay the ground work for personalized
health care and its vision for the future saying that biomedical science,
health information technology, and health care delivery must be aligned
to produce “the right treatment, at the right time” for each
individual patient. The report, Personalized Health Care: Opportunities, Pathways, Resources,
presents a long-range plan for achieving much more individualized treatment
for patients, especially by using genetic information and health information
technology (IT). Health care professionals have always aimed at
making medical care as individualized as possible. But in truth,
our ability to deliver the right care for each person has been limited,” Secretary
Leavitt writes in a foreword to the report. Delivering the right care
to the right patient at the right time is a component of the Institute
of Medicine’s six aims for quality health care. The report describes how the exploding knowledge of the human genome
will increase the capacity to predict, detect, preempt and treat disease,
by enabling physicians to “look beneath” visible symptoms
and see signs and causes of disease at the molecular level. The
report also describes how health IT can make patient information accessible
securely, while maintaining confidentially, as well as how it can support
high quality care. Health IT can help clinicians and researchers
ascertain which treatments are most effective and for whom, by using
broad-scale data derived from day-to-day medical practice, said Secretary
Leavitt. An inventory of programs already underway throughout HHS that support
personalized health care is included. Some of those programs include: The report is available on the HHS Web site at http://www.hhs.gov/myhealthcare/. Judith A. Salerno, MD, a national leader on aging research, long-term
care, and other health policy issues related to aging, chronic disease,
and disability, has been appointed as the new executive officer of the
Institute of Medicine. Dr. Salerno will begin managing operations
for IOM and supporting its governance and membership activities in January
2008. Dr. Salerno comes to IOM from the National Institute on Aging of the
National Institutes of Health where she serves as deputy director. She
is also NIA’s senior geriatrician and serves on numerous national
committees concerned with the quality of long-term care and with geriatric
work force and veterans’ health care issues. In addition
to receiving numerous awards for leadership, her expertise has been tapped
by members of Congress and their staffs at many hearings and briefings. Dr. Salerno holds a medical degree from Harvard Medical School and a
master’s of science degree in health policy from the Harvard School
of Public Health. Prior to her appointment as NIA’s deputy
director, she served as chief consultant for geriatrics and extended
care for the U.S. Department of Veterans Affairs where she launched initiatives
to improve pain management and end-of-life care across the VA health
system.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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