| AZ Annual Medical Services Review Report | |
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Summer 2010 Arizona Edition: Volume 1, Issue 2 |
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 HSAG Relocates to New Offices in Phoenix
Health Services Advisory Group, Inc. (HSAG), the quality improvement organization (QIO) for Arizona, is relocating to new headquarters effective July 26 to better serve its customers. HSAG’s new offices are only a few miles from its current location at 1600 East Northern, Phoenix.
The new location is:
3133 East Camelback Road
Suite 300
Phoenix, AZ 85016-4501
The organization's main telephone and FAX numbers will remain the same:
Main number: 602.264.6382
FAX number: 602.241.0757
For more details, visit http://www.hsag.com/news/relocation.aspx.
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MedPAC Releases Report on Medicare Payment Policy
The Medicare Payment Advisory Commission (MedPAC—a Congressional agency that provides independent, non-partisan policy and technical advice to the Congress on issues affecting the Medicare program) has released its 2010 Report to the Congress: Aligning Incentives in Medicare. The report focuses on how incentives in the Medicare program can be leveraged to promote quality of care and efficient use of resources—key elements of a high-value health care delivery system.
In Aligning Incentives in Medicare, the Commission explores policies that highlight the role of the Centers for Medicare & Medicaid Services (CMS) and Medicare beneficiaries in achieving the goal of delivery system reform. Highlights from the report include:
- A recommendation that a significant portion of Medicare’s graduate medical education payments be contingent on residency programs meeting key educational criteria, such as team-based care, training in ambulatory settings, and measuring quality.
- The need for Medicare to have greater flexibility to be an innovative purchaser of health care.
- Reforms that could protect beneficiaries with the greatest need for services and who currently face very high cost sharing. It also discusses changes to out-of-pocket spending that would create incentives for beneficiaries to access high-value health care services.
- A discussion of ways to motivate quality improvement among providers in Medicare through technical assistance and reforming Medicare’s conditions of participation.
- An appendix, required by law, in which the Commission reviews CMS’ preliminary estimate of the physician update for 2011.
The entire report can be downloaded at http://medpac.gov/documents/Jun10_EntireReport.pdf.
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 SCIP Rapid-Cycle Intervention Pilot
In the spring of 2010, HSAG implemented a rapid-cycle intervention pilot program with a select group of Arizona hospitals participating in the CMS Surgical Care Improvement Project (SCIP) Collaborative. The goal of the pilot was to develop and implement a process whereby surgical departments could identify and correct care deficiencies before they become part of the permanent record. A concurrent chart-review approach was designed—and forms and other supporting materials were developed—to facilitate project implementation. To read more about the pilot and to review the forms, visit Past Events: HSAG Combined SCIP/MRSA Learning Session, May 13, 2010, at http://www.hsag.com/azhospitals/scip/events.aspx.
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Prevention of Surgical-Site Infections: Best Practices, Better Outcomes
This continuing medical education (CME) video transcript is directed toward surgeons, infectious disease specialists, hospitalists, emergency medicine physicians, nurses, and nurse practitioners. The video highlights best practices for prevention of surgical-site infections as a strategy for improving outcomes in surgical patients. Speakers include E. Patchen Dillinger, MD; Steven Gordon, MD; and Richard Wenzel, MD. The CME credit is good through April 2011. Accessing this document requires creating a free account on Medscape if you do not already have one. Visit http://cme.medscape.com/viewarticle/720011 to create an account and view the transcript.
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AHRQ’s HAI Web Resources
The Agency for Healthcare Research and Quality’s (AHRQ’s) Healthcare-Associated Infections (HAIs) Web page features helpful links to information, tools, and resources on HAIs—which are the most common complication of hospital care and one of the top 10 leading causes of death in the United States. To view these resources, visit http://www.ahrq.gov/qual/hais.htm.
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Interruptions Linked to Medication Errors by Nurses
This CME article, good through May 2011, is intended for primary care clinicians, nurses, nurse administrators, hospitalists, and other specialists who care for hospitalized patients. The article states that for each interruption, there was a 12.1 percent increase in process failures and a 12.7 percent increase in clinical errors. The article also discusses the need for interruptions to be reduced, provides additional resources, and discusses clinical implications. Accessing this article requires creating a free account on Medscape if you do not already have one. To create an account and view the article, visit http://cme.medscape.com/viewarticle/721136?src=cme_mp_top&uac=42416EX.
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Sentinel Event Alert: Preventing Violence in the Health Care Setting
The Joint Commission (TJC) issued a Sentinel Event Alert in June that discusses the rise of violent crimes within health care institutions. The alert identifies high-risk areas, discusses prevention strategies, and identifies TJC-suggested actions. To view the alert, visit http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_45.htm.
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Blogging About Safe Health Care
The Centers for Disease Control and Prevention (CDC) hosts a blog site that features comments and testimonies from renowned infectious disease specialists. Readers are encouraged to blog about topics such as appropriate antibiotic use, tracking infections, and catheter-associated urinary tract infections (CAUTIs). Visit http://blogs.cdc.gov/safehealthcare for more information.
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AzHHA Names New President and CEO
The Arizona Hospital and Healthcare Association (AzHHA) Board of Directors has named Laurie Liles as its new president and chief executive officer. Liles, who now leads AzHHA’s legislative and regulatory advocacy team, will begin her new role on September 7. For more information, visit http://www.azhha.org.
Hospital Events and Resources
October 14–15, 2010
2010 AzHHA Annual Membership Conference: "Bringing the Future into Focus"
Tempe, Arizona
Important Upcoming RHQDAPU Dates
- Hospital Compare Preview Reports Available: July 12–August 10
- 1Q 2010 Inpatient Population and Sampling Deadline: August 1
- Request for Witholding Data from Public Reporting Forums Deadline: August 10
- 1Q 2010 Inpatient Clinical Data Submission Deadline: August 15
- Document Structural Measures Information Deadline: August 15
- Data Accuracy and Completeness Acknowledgement Deadline: August 15
HSAG provides all Arizona hospitals with notifications and reminders—with detailed instructions—for each of these CMS requirements. For questions or assistance, please contact Suzette Gerhart at sgerhart@azqio.sdps.org or at 602.745.6299.
New Resource:
Venous Thromboembolism & Prophylaxis in the Surgical Patient—A SCIP Quality Measure Self-Learning Module for Hospital Staff: available at http://www.hsag.com/azhospitals/scip/resources.aspx.
For more information on HSAG's hospital initiatives, visit:
http://www.hsag.com/azhospitals/default.aspx. | |
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 MDS 2.0 to MDS 3.0 Transition Timeline
The Centers for Medicare & Medicaid Services has posted an MDS 2.0 to MDS 3.0 Transition Timeline on its Web site. To view the Timeline, visit: https://www.cms.gov/NursingHomeQualityInits/downloads/ MDS302010ImplementationTimeline.pdf.
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MDS 3.0 Video Resource—VIVE
Changes included on the MDS 3.0 involve bringing the resident’s voice directly into the assessment. As a result, several sections of the MDS 3.0 will rely on direct-resident interviews. A video resource, titled "Video on Interviewing Vulnerable Elders," (VIVE) was funded by the Picker Institute and produced by the UCLA/JH Borun Center. The video helps train staff members to use effective interview techniques. To view the video and access other MDS 3.0 training materials, visit https://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp.
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Advancing Excellence Campaign Resources
The Advancing Excellence in America’s Nursing Homes National Campaign helps nursing homes achieve excellence in the quality of care and quality of life of nursing home residents. To achieve its mission, the Advancing Excellence Campaign provides free, evidence-based resources that nursing homes can use to support their quality improvement efforts. Some resources available on the Advancing Excellence Web site include:
HSAG is the Advancing Excellence Local Area Network for Excellence (LANE) convener in Arizona and responsible for coordinating and facilitating campaign activities throughout the state. Nursing homes are encouraged to join the campaign and track performance on specific goals. To find out more about the Advancing Excellence Campaign, visit http://www.nhqualitycampaign.org.
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The Nurse’s Role in Nursing Home Culture Change
There is growing evidence that nursing home culture change improves residents’ quality of life, improves staff satisfaction, and creates positive financial outcomes for organizations. Yet to evolve are the roles nurses play in a nursing home organization’s culture change transformation. The Hartford Institute for Geriatric Nursing, in collaboration with the Coalition of Geriatric Nursing Organizations and the Pioneer Network, has convened an interdisciplinary panel of experts on culture change and gerontological nursing to develop a set of competencies for licensed nurses to promote and facilitate person-centered care and culture change in their organizations. To view the report, visit http://www.pioneernetwork.net/Data/Documents/TenCompetenciesReport0510.pdf.
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 Final "Meaningful Use" Rule
On July 13, 2010, The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health Information Technology announced two complementary Final Rules to implement the Electronic Health Record (EHR) Incentive Program under the Health Information Technology for Economic and Clinical Health (HITECH) Act. Below are the links to the Final Rules:
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
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ONC Issues Final Rule to Establish Temporary Certification Program for EHR Technology
The ONC for Health Information Technology (HIT) has established a temporary certification program for HIT. The program allows organizations to become authorized by the National Coordinator to test and certify EHR technology.
Use of certified EHR technology is a core requirement for health care providers to become “meaningful users” and eligible for payment under Medicare and Medicaid EHR incentive programs. To provide assurance to health care providers that the EHR technology they adopt will assist their achievement of meaningful use, the Department of Health and Human Services (DHHS) issued a final rule to establish a temporary certification program for EHR technology on June 18, 2010.
For more information, visit:
http://healthit.hhs.gov/portal/server.pt?open=512&objID=2885& parentname=CommunityPage&parentid=72&mode=2&in_hi_userid=12059&cached=true.
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CMS Launches EHR Incentive Program Web Site
CMS launched the official Medicare & Medicaid EHR incentive programs Web site, which provides the most up-to-date, detailed information about these programs. The Medicare & Medicaid EHR incentive programs provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Bookmark http://www.cms.gov/EHRIncentivePrograms and visit often to learn about program eligibility, registration opportunities, meaningful use, and upcoming EHR training and events.
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Medicare and the New Health Law—What it Means for You
The Affordable Care Act (ACA) passed by Congress and signed by President Obama this year will provide Medicare beneficiaries with greater savings and increased quality health care. CMS has produced the "Medicare and the New Health Law—What it Means for You" brochure, which provides Medicare beneficiaries with accurate information about new services and benefits and outlines key provisions of the ACA. Beginning next year, the ACA ensures that Medicare beneficiaries receive free preventive care services, including colorectal cancer screenings and mammograms—in addition to the free annual wellness visit.
To download the English or Spanish versions of the brochure, visit http://www.medicare.gov/Publications/Search/Results.asp?PubID=11467&Type=PubID.
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Physician Deadline for Medicare PECOS Enrollment Moved Up to July 2010
On June 14, American Medical News reported that the enrollment compliance date for physicians for the Provider, Enrollment, Chain and Ownership System (PECOS) has been moved up to July 6, 2010. CMS said a new mandate from the health reform law forced the deadline change, originally scheduled for January 2011. PECOS enrollment compliance applies to doctors who order or refer most types of covered Medicare services. Physicians state that a major flaw with the PECOS requirement is the potential to interrupt their Medicare cash flow. The American Medical Association is currently working with CMS to mitigate the impact of the July 6 date, including an option to ensure claims processing is not interrupted.
For more information, visit
http://www.ama-assn.org/amednews/2010/06/14/gvl10614.htm.
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IOM Calls for Exploiting Existing Data for Better Cancer Treatment
"Rapid learning" systems that use large EHR databases can quickly advance the delivery of cancer care and accelerate research, according to a new report from the Institute of Medicine (IOM). These systems can be examined to see how to improve treatment and accelerate advances in cancer management by applying the concept of a rapid learning health system using advances in information technology and improved information sources to deliver the best care, personalized for each patient. To read the entire report, visit http://www.healthcareitnews.com/news/iom-calls-exploiting-existing-data-better-cancer-treatment.
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New CDC Study Finds Colorectal Cancer Screening Practices Need Improvement
More than 75 percent of primary care physicians in the U.S. who order or perform the fecal occult blood test (FOBT) as a screening option for colorectal cancer use an in-office test rather than relying on the home-based test, even though the home-based test is more accurate, a study by the Centers for Disease Control and Prevention (CDC) has found. To view the full press release, visit http://www.cdc.gov/media/pressrel/2010/r100415a.htm.
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 CMS Signature Guidelines
The Centers for Medicare & Medicaid Services (CMS) uses transmittals to communicate new or changed policies or procedures that will be incorporated into the CMS Online Manual System. Transmittal 327 outlines the signature guidelines contractors need to follow when reviewing medical record documentation and payment of claims. It applies to all Medicare contractors, including Medicare administrative contractors and recovery audit contractors. It also includes useful guidance for providers by specifically outlining what contractors will accept as a signature and when contractors need to query the provider for additional information.
The Transmittal also instructs contractors to disregard unsigned orders. When an unsigned order is found during a review, it does not appear that contractors will have the option of requesting additional information from the provider to substantiate the claim, as CMS has indicated that an unsigned order will be considered invalid. CMS permits the following as acceptable means of authentication:
- Electronic signature.
- A legible, handwritten signature, including the author's first and last name.
- Additional documentation such as a signature key, signature log, or an attestation statement submitted with the medical record to support an illegible or unclear signature.
- CMS includes a proposed attestation statement on page 11 of the Transmittal.
Pages 12 and 13 of the Transmittal contain a table that lists the actions contractors will take in response to specific signature situations. For more information, visit http://ohima.informz.net/z/cjUucD9taT04NTc4NTEmcD0x JnU9MTAyMDI1MzgzMCZsaT0zMzU1MjU5/index.html.
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The Medical Record Request Process
Each provider must have a process in place to ensure that medical record requests are completed and returned in the time frame indicated in the request. Prior to submitting a medical record to a contractor for review, providers should perform the following:
- Verify that all requested information is in the medical record, including the patient’s name, dates of service, and all test results and reports.
- Review the medical record to ensure that all medical record entries are signed by the author and are legible. If a signature is not legible, include a signature key, signature log, or attestation statement.
- If a protocol or standing order was used, include or provide a copy of the applicable protocol or standing order with the medical record.
Due to the increasing number of medical record reviews providers are subject to, it is critical that the necessary steps are taken to comply with the signature requirements outlined by CMS. If you have any questions, please contact the Regs Helpline at regs.helpline@hcahealthcare.com.
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Aftercare Tips for Patients Checking Out of the Hospital
A recent New York Times article discusses important tips for smooth transitions for patients checking out of the hospital. The article stresses the importance of taking an active role in the discharge process to ensure smooth transitions of care and avoid unnecessary rehospitalizations. According to a study published last year in the New England Journal of Medicine, one in five Medicare patients returns to the hospital within 30 days of being discharged. The problem is an expensive one: in 2004, these readmissions cost Medicare $17.4 billion dollars.
In addition to being an advocate, the article suggests making sure to reconcile medication lists, compiling your own discharge plan, and contacting the patient’s primary doctor. The article also suggests speaking up if you believe the hospital is sending a patient home too soon. If talking to the doctor doesn’t work, talk with the hospital’s patient advocate. All Medicare patients have the right to appeal their discharge from a hospital or other health care setting and can call HSAG—Arizona’s Medicare Quality Improvement Organization—at 1-800-359-9909 to file a discharge appeal or quality-of-care concern. For more information on the discharge appeals process or to file a quality-of-care concern, visit http://www.hsag.com/azmedicare.aspx.
To view the entire New York Times article, visit http://www.nytimes.com/2010/06/19/health/19patient.html. |
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 Clinical and Economic Outcomes Associated with Potentially Inappropriate Prescribing in the Elderly
A recent American Journal of Managed Care study, titled "Clinical and Economic Outcomes Associated with Potentially Inappropriate Prescribing in the Elderly," evaluates the risk of adverse events and the health care costs for elderly patients receiving specific potentially inappropriate medications. Visit http://www.ajmc.com/media/pdf/AJMC_2010Jan_StocklWeb_e1_e10.pdf to read this article.
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Medication Reconciliation
This chapter in the Agency for Healthcare Research and Quality (AHRQ) publication, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, reviews the evidence for medication reconciliation and makes recommendations for nursing practice. The chapter includes information on safety vulnerabilities, reconciliation in various settings, transfers and admissions to different health care settings, medication history accuracy with electronic health records, and evidence-based practice implications. To read this chapter, visit http://www.ahrq.gov/qual/nurseshdbk/docs/BarnsteinerJ_MR.pdf.
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Drugs to Avoid in the Elderly
This resource, developed by the Oklahoma Foundation for Medical Quality in collaboration with the University of Oklahoma College of Pharmacy, Institute for Geriatric Pharmacy, can be used to improve safety in prescribing for elderly patients. Click here to view the resource: https://www.qualitynet.org/dcs/ContentServer?c=OtherResource&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&cid=1228756022826.
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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-071210-01.
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