| AZ Annual Medical Services Review Report | |
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Spring 2010 Arizona Edition: Volume 1, Issue 1 |
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Welcome to the New HSAG Connection newsletter. We hope you will find this information helpful.
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 AHRQ Releases 2009 National Healthcare Quality Report
Healthcare quality in America continues to be suboptimal, according to the seventh National Healthcare Quality Report (NHQR) released on April 13 by the Agency for Healthcare Research and Quality (AHRQ). The report concludes that while quality is improving, the pace is slow—especially for preventive care and chronic disease management.
The NHQR, mandated by the U.S. Congress in 2003, is built on more than 200 measures categorized across four dimensions of quality: effectiveness, patient safety, timeliness, and patient centeredness. Here are some highlights from the report:
- Significant improvement in hospital care has occurred since the Centers for Medicare & Medicaid Services (CMS) began reporting consensus-based quality measures on the Hospital Compare Web site. Of the 10 fastest improving measures tracked in the NHQR, 8 were measures published on the CMS Web site.
- In hospitals, safety remains a significant problem. Of the 33 hospital measures related to safety, 12 (36 percent) improved at a rate greater than 5 percent per year. In contrast, of the 19 hospital measures not related to safety, 16 (84 percent) improved at a rate greater than 5 percent per year.
- Infections acquired during hospital care are one of the most serious patient safety concerns. Of the four healthcare-acquired infection (HAI) outcome measures tracked, only one shows improvement over time while three are worsening and one shows no change. Of all the measures in the NHQR measure set, the one worsening at the fastest rate is postoperative sepsis.
- Improvement in preventive services and chronic disease management lagged behind improvement in acute disease treatment. Of the nine process measures tracked in the NHQR that got worse instead of better, four were preventive services—including mammography, Pap testing, and fecal occult blood testing. Four services were related to chronic disease management, including three services for patients with diabetes.
The entire NHQR may be downloaded at http://www.ahrq.gov/qual/qrdr09.htm.
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CMS Updates Medicare Consumer Web Site
CMS has posted a new and easier to use version of www.medicare.gov, the Medicare consumer-focused Web site. The updated Web site is one of the steps Medicare is taking to make it easier for beneficiaries and people who care for them to find the information they need about Medicare and health care services. The improved Web site provides users with a summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions about Medicare. The Web site is also the gateway to Hospital Compare, Nursing Home Compare, Home Health Compare, Dialysis Facility Compare, and Medicare Options Compare.
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 MATCH Initiative
The Medications At Transitions and Clinical Handoffs (MATCH) Initiative was developed through the support of the Agency for Healthcare Research and Quality (Grant No. 5 U18 HS015886) and collaboration between Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, and The Joint Commission. The goal of the MATCH Initiative is to measurably decrease the number of discrepant medication orders and the associated potential and actual patient harm. Part of this initiative includes a MATCH Toolkit designed to:
- Make the case for prioritizing medication reconciliation as a patient safety program in an organization.
- Define the problem by outlining successful practices and identifying current deficiencies within an organization or practice setting.
- Develop a new or redesign an existing medication reconciliation process to meet patient safety goals and integrate into staff's workflow.
- Test and implement a new or enhanced medication reconciliation process throughout an organization or within a practice setting.
- Assess and evaluate a process post-implementation to achieve sustainable results.
- Inform and involve patients, families, and caregivers in the medication reconciliation process.
For more information and to view the Toolkit, please visit http://www.nmh.org/nm/for physicians match.
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Unmet Needs: Teaching Physicians to Provide Safe Patient Care
Ten years after the Institute of Medicine's Landmark 1999 report To Err Is Human, The Lucian Leape Institute (LLI) at the National Patient Safety Foundation has released a white paper finding that U.S. medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care.
The white paper, titled Unmet Needs: Teaching Physicians to Provide Safe Patient Care, is the culmination of three LLI roundtable discussions and makes key recommendations for reforming medical education in order to improve patient safety. The paper is the first in a planned series of such reports on issues that the LLI has identified as top priorities in ongoing efforts to improve patient safety.
To view the white paper, please visit: http://www.npsf.org/download/LLI-Unmet-Needs-Report.pdf.
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Team-Based Care: There's no "I" in Team
Health care is a team sport, but all too often practitioners act as individual players. Studies from The Joint Commission, VHA, and others point to poor communication between caregivers as one of the top causes of medical errors and near misses. AHRQ, along with the Department of Defense, has been giving hospitals and practitioners a boot camp in team-based care since 2006 through TeamSTEPPS. The TeamSTEPPS program focuses on building core competencies in teamwork and aims to improve the quality and safety of care.
There are a lot of things standing in the way of people working effectively and efficiently as a team. Barriers, to name just a few, include culture, technology, and training. Overcoming these barriers involves agreeing on a shared commitment: Teams don't have to work together on a permanent basis, but team-based care is dependent on a shared commitment to building skills and attitudes. These include mutual performance monitoring, backup behavior, shared mental models, closed-loop communication, and mutual trust.
For more information on the barriers of collaboration and how to overcome them, visit http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/03MAR2010/1003HHN_FEA_gatefold&domain=HHNMAG.
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 The New CMS QIS Process
The Arizona Department of Health Services (ADHS) is currently making the transition from the traditional nursing home survey process to the Centers for Medicare & Medicaid Services (CMS) Quality Indicator Survey (QIS) process. The QIS is a two-stage process used by surveyors to systematically review specific nursing home requirements and objectively investigate any regulatory areas that are triggered. Although the survey process has been revised, the federal regulations and interpretive guidance remain unchanged. To help your nursing home prepare for the new CMS QIS process, please visit the University of Colorado Denver Web site and download the QIS Surveyor Training Manual—including forms and procedures—at http://www.uchsc.edu/hcpr/qis_manual.php.
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The MDS Draft 3.0
CMS is making the transition from the Minimum Data Set (MDS) 2.0 to the new MDS 3.0 beginning October 1, 2010.To view the MDS Draft 3.0—including the new draft Resident Assessment Instrument Manual—please visit: http://www.cms.hhs.gov/Nursinghomequalityinits/25_NHQIMDS30.asp.
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Avoiding Common ADLs Coding Errors
It is important to recognize common activities of daily living (ADLs) coding errors so that they can be avoided. Here are just a few:
- Failure to recognize self-performance may vary from day to day and shift to shift. The total picture must be considered over the complete 24-hour, 7-day look-back period.
- Failure to code to a resident's actually used level of staff support. It only takes three instances of higher levels of support to trigger the higher rating (limited assistance to extensive assistance).
- Coding what a resident is capable of performing instead of what he or she actually performed.
- Considering only one component in the bed mobility and transfer coding categories. It only takes three instances of higher levels of support to trigger the higher rating.
For more information on how to avoid ADLs coding errors and how this relates to pressure ulcer prevention, view HSAG's Pressure Ulcer High-Risk Stratification Quality Measure Sheet at:
http://www.hsag.com/App_Resources/Documents/HSAG_PrU_LS6_QM_Sheet.pdf.
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 Regional Extension Centers Funded to Assist EHR Adoption
The U.S. Department of Health and Human Services has completed its funding awards (totaling over $642 M) to 60 Health Information Technology Regional Extension Centers (RECs) that are charged with offering technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of electronic health records (EHRs). The Health Information Technology for Economic and Clinical Health Act (HITECH Act) authorized the creation of the RECs and a national Health Information Technology Research Center (HITRC). The HITRC will identify and share best practices in EHR adoption, effective use, and provider support. It will also assist the RECs in collaborating with one another and relevant stakeholders.
The RECs are designed to ensure that primary care clinicians who need help are provided with an array of on-the-ground support to meaningfully use electronic health records (EHRs). Providing training and support services, the RECs will assist physicians and other providers in the adoption and meaningful use of EHR systems. The goal of the program, which has coverage in virtually every geographic region of the United States, is to provide outreach and support services to at least 100,000 priority primary care providers within two years.
Of the 60 awards, one is to Arizona Health-e Connection. For a complete listing of REC Awardees, visit http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&mode=2.
Arizona primary care providers who are interested in receiving EHR assistance under the REC program may contact Kim Harris-Salamone, PhD, HSAG Executive Director of Health Information Technology, at ksalamone@hsag.com or 602-745-6217.
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Become a "Meaningful User" of Certified EHR Technology
The American Recovery and Reinvestment Act (ARRA) of 2009 authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals (EPs) who are successful in becoming "meaningful users" of certified electronic health record (EHR) technology. The Medicare EHR incentive program will provide incentive payments to EPs that are meaningful users of certified EHR technology. Current participation in the CMS Quality Improvement Organization (QIO) 9th Scope of Work helps prepare physician practices for the Medicare 2011 incentive funds identified by the ARRA. Three out of the four prevention measures in the CMS 9th Scope of Work are part of the meaningful use criteria included in Stage 1 of the incentive program, which begins January 2011.
In Stage 1, EPs are required to submit summary quality measure data to CMS by attestation (2011). To satisfy the requirements of reporting on clinical quality measures for Medicare, CMS proposes to require each EP to submit clinical data on two measure groups—core measures and a subset of clinical measures most appropriate to the EP's specialty.
For more information on meeting proposed "meaningful use" Stage 1 criteria and the associated objectives, visit: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0_18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf.
For information on the stages of meaningful use criteria by payment year, visit: http://wiki.hl7.org/images/2/28/2009-31217_PI_Table1.pdf.
For more information on the meaningful use of EHRs, visit: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1325&parentname=CommunityPage&parentid=1&mode=2.
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"How to Increase Colorectal Cancer Screening Rates in Practice" Toolbox and Guide
Created by clinicians for clinicians, the How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-based Toolbox and Guide can help improve colorectal cancer screening in your practice and provide advice to help make your screening practices more efficient. The Guide is available through the Web sites of the National Colorectal Cancer Roundtable (www.nccrt.org) and the American Cancer Society (www.cancer.org/colonmd) under "For Your Clinical Practice."
To download the How to Increase Colorectal Cancer Screening rates in Practice flyer, visit
http://www.hsag.com/App_Resources/Documents/How_to_Increase_CRC_Screeening.pdf.
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 Hospital Discharge Appeals Process Steps
Below are the first 4 of 10 steps that describe the hospital discharge appeals process for beneficiaries and explain the role of the Medicare Quality Improvement Organization (QIO). HSAG is the QIO for Arizona.
- A hospital must issue the "Important Message from Medicare" to the beneficiary or representative: (1) at time of admission and (2) within 48 hours prior to discharge. Please note that if the beneficiary is being discharged to a long-term acute care (LTAC) hospital, the hospital does not have to issue the "Important Message from Medicare," and there is no appeal to the QIO because the beneficiary is not being discharged to a lower level of care. Hospitals may issue a Liability Notice (HINN 12) to those beneficiaries who have an order to transfer to an LTAC with an accepting facility when the beneficiary refuses to go.
- The beneficiary or representative must call HSAG at 1-800-359-9909 by midnight of the discharge date: (1) in order for the appeal to be considered timely, and (2) so that the beneficiary will have no financial liability for any days after the appeal until noon of the day after the QIO's determination.
- HSAG will contact the hospital designated point of contact by 4:30 p.m. on the day of the appeal to notify him or her that an appeal has been filed. HSAG will request medical records from the hospital. Please note that if the hospital does not specify an appeal point of contact, all communication will be directed to the hospital’s QIO Liaison.
- The hospital and/or Medicare Health Plan must issue the Detailed Notice to the beneficiary or the beneficiary’s representative by noon on the day after QIO notification.
For all 10 steps related to the hospital discharge appeals process, visit: http://www.hsag.com/App_Resources/Documents/Hospital_Appeals_Steps.pdf.
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FAQs—Hospital Discharge Appeals
Question:
Is the patient ID number on the "Important Message from Medicare" the beneficiary’s Medicare number?
Answer:
No. The ID number can be a number that identifies the beneficiary, such as a medical record number. The number should not be or contain any part of the beneficiary's Social Security number.
Question:
Does the "Important Message from Medicare" need to be issued to beneficiaries who have Medicare as a secondary payer?
Answer:
Yes. It must be issued even if Medicare is the secondary payer.
Question:
Should beneficiaries receive the "Important Message from Medicare" while they are in the emergency department or in observation status?
Answer:
No. The "Important Message from Medicare" is only for beneficiaries who have an inpatient admission.
Question:
When should the Detailed Notice be delivered?
Answer:
The Detailed Notice should be delivered as soon as possible after a beneficiary requests a QIO review, but no later than noon of the day after the QIO notifies the hospital of the appeal.
For more FAQs on hospital discharge appeals, visit: http://www.hsag.com/App_Resources/Documents/Hospital_Appeals_FAQs.pdf.
To download all of the forms and instructions, please visit http://www.cms.gov/BNI/.
For more information on appeals, visit http://www.hsag.com/azproviders/appeals.aspx |
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HSAG Contacts
Hospitals and Drug Safety:
Charlie Chapin, MS, CHCA, Director, Decision Support, 602.665.6107
Nursing Homes:
Joe Bestic, NHA, BA, Director, Nursing Home, 602.745.6205
Physician Offices:
Hector Cariello, MPH, Physician Office Project Manager, 602.665.6132
Case Review:
Suzanne Powell, RN, MBA, CPHQ, CCM, Director, Quality Improvement, 602.665.6109
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We welcome your feedback! Please e-mail: lcooper@hsag.com
This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-9SOW-XC-050510-01.
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