| CA Hospital Inpatient Quality Reporting | |
| CA Annual Medical Services Review Report | |
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Spring 2010 California 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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 Scripps Timeout Video
The surgical team at Scripps Memorial Hospital La Jolla has created and implemented new checklists for the Time Out process based on the World Health Organization's three-part checklist. The hospital designed the checklists to be specialty-specific to address the unique issues of each surgical specialty. To augment their efforts in implementing the checklists by OR teams and improving the Time Out process, the hospital created a video outlining the entire process from preinduction of the patient to sign out. The video has been used to educate staff members and physicians to ensure adherence to the processes, as well as consistency in utilization of the Time Out process.
For more information and to view the video, please click here.
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Improving Surgical Care Through Best-Practice Literature and Order Sets
A case study posted on www.whynotthebest.org, an online health care quality improvement resource created and maintained by The Commonwealth Fund, describes the dramatic improvement made by St. Charles Hospital (2004–2008) on process-of-care (or core) measures, particularly on those intended to reduce surgical complications. Conversations with administrative and clinical staff indicate that St Charles' achievements in surgical care can be attributed to a hospital-wide focus on quality improvement spurred by involvement in the Centers for Medicare & Medicaid Services (CMS) Surgical Care Improvement Project (SCIP), as well as to reliance on best-practice literature to get surgeons on board, use of preprinted order sets to standardize care processes, and maintaining a steady focus on tracking performance data and communicating results to physicians and other staff members.
For more information on this case study, visit http://www.whynotthebest.org/contents/view/59.
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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 to 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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RHQDAPU
Did you know that over 300 of California’s acute care PPS hospitals participate in the Medicare Reporting Hospital Quality Data Annual Payment Update (RHQDAPU) program? HSAG of California, the Medicare Quality Improvement Organization (QIO) for California, helps hospitals by providing technical assistance to actively promote and support the submission of quality data for the program.
The HSAG of California RHQDAPU Team provides program education and technical assistance through multiple venues. Staff members prepare and present quarterly Webinars that provide education on changes to the specification measures and the program, as well as provide tips for effective abstraction.
The Team also develops tools and tip sheets and sends reminders to the hospital community on upcoming deadlines for the program. One-on-one education and/or assistance via teleconference or e-mail is also provided. An e-mail listserv is available for hospitals to join. Through this listserv, hospitals receive updates on clinical measures, the Specifications Manual, data collection and submission, and public reporting requirements. To join the e-mail listserv, visit http://www.hsag.com/cahospitals/qdr.aspx.
To access any of our recorded educational Webinars, tools, and tip sheets, please visit: http://www.hsag.com/caproviders/events.aspx and http://www.hsag.com/caproviders/rhqdapu.aspx.
To contact the RHQDAPU Team or obtain official RHQDAPU information, please visit the QualityNet Web site at: http://www.qualitynet.org. Contact information is located under the Hospital—Inpatient Tab, RHQDAPU Section, in the left-side menu. Look for the QIO contacts icon. Contacts are listed by state.
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Providence Tarzana Medical Center Patient Safety Fair
Kudos to Providence Tarzana Medical Center for celebrating Patient Safety Awareness Week (PSAW) on March 10, 2010. PSAW is a national education and awareness-building campaign to improve patient safety at the local level. This was the 11th year that Providence Tarzana held its Patient Safety Fair, at which more than 30 different teams presented TV-show themed patient-safety poster boards. The pressure ulcer team’s poster chose the TV show, "Get Smart," and presented their poster board, "Get Smart about Pressure Ulcers," that highlighted their performance data and pressure ulcer education. More than 300 patients and staff members attended the Fair.
For more information, please contact Susan Hiyama, RN, MSN, CPHQ, HSAG of California Quality Improvement Specialist.
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 California Nursing Facility Shines with HSAG of California's Help
The director of nursing at Upland Rehabilitation and Care Center in Upland, California, didn't think she could do much better reducing the facility's restraint numbers two years ago—not until she linked up with the staff at HSAG of California, that is.
"The numbers were crazy when I first came here," said Dulce Posa, who joined Upland as nursing director in January 2006. "The restraint numbers were 66 on a census of 180. Three years later we went down to 35. I thought, this is it, I'm done. I didn't think I could do anything more about it."
That's when the staff at HSAG's California office stepped in. In December 2008, Upland began working collaboratively with HSAG of California to improve the rates of pressure ulcers and restraints. Today, Upland's restraint numbers are in the single digits, at six, and the facility has won a clinical excellence award from its parent company, the Ensign Group, as well.
Sheila Gray, quality improvement specialist in the California office, was "relentless" with her coordination and with a barrage of informational materials, Dulce said. This material included a checklist that has been a vital tool in reducing the facility's restraint numbers, she added.
To read the entire interview, please visit http://www.hsag.com/news/nursinghome.aspx.
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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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Person-Centered Care: Adult Abuse and Neglect Prevention
The principles of person-centered care provide a foundation for abuse prevention and quality care for nursing home residents. The goal of person-centered care is to empower residents and engage them as active participants in their plan of care, giving them a voice and options to make decisions on their own.
Inappropriate restraints and the failure to reposition nursing home residents (which can lead to pressure ulcers) are examples of abuse and neglect situations in nursing homes. By instituting the concepts and goals of person-centered care into the everyday life of residents, nursing homes can not only help prevent abuse, but they can also transform their organizations from being task-focused and treatment-oriented to being relationship-focused and care-oriented.
Person-centered care training modules that deal with abuse and neglect prevention, called Facilitator Instruction Modules (FIMs), were developed by BEAM, in cooperation with Michigan State University and the Michigan Office of Services to the Aging. These were made possible through a Michigan Department of Community Health Grant awarded by CMS. The curricula committee translated the original information into 12 instructional modules. These modules can be accessed by visiting MI Seniors—Michigan Office of Services to the Aging at:
http://www.michigan.gov/miseniors/0,1607,7-234-49992_49993---,00.html.
Please contact Jennifer Wieckowski, MSG, Manager, Nursing Homes, if you are interested in training on these modules.
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Poster: "Help Make Pressure Ulcers a Thing of the PAST"
The PAST acronym reminds caregivers to Prevent, Assess, Stage, and Treat pressure ulcers in the nursing home setting. Additional information is provided to supplement each of the four categories to help staff members provide good skin care to their patients/residents.
To download the PAST poster, visit http://www.hsag.com/App_Resources/Documents/CA_PrU_PAST_Poster.pdf.
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California's Pressure Ulcer and Physical Restraint Performance Improvement
Although California currently ranks 49th in the nation for physical restraint rates, the state's improvement has been consistent. California's state average for restraints in January 2009 was 7.4 percent and has currently improved to 5.7 percent. The national average for restraints is 3.0 percent.
California currently ranks 45th in the nation for pressure ulcer rates. In January 2009 the state average for pressure ulcers was 14.5 percent and has currently improved to 13.4 percent. The national average for pressure ulcers is 12.3 percent.
These data come from publicly reported measures, which include residents who were admitted to nursing homes with existing pressure ulcers. The new MDS 3.0 will help address some of these problems by eliminating reverse staging for pressure ulcers, assessing unstageable pressure ulcers as a separate item, and collecting the number of pressure ulcers present on admission. Nevertheless, this emphasizes the importance of California hospitals, nursing homes, and other health care settings to work together to prevent pressure ulcers for Californians at risk.
For more information on pressure ulcer prevention and quality improvement, visit HSAG of California's Nursing Home Web Section at http://www.hsag.com/canursinghomes/default.aspx, or visit the Advancing Excellence in America's Nursing Home Quality Campaign at: http://www.nhqualitycampaign.org.
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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, three are for California:
For a complete listing of REC Awardees, visit http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&mode=2.
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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 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 of California is the QIO for California.
- 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 1-800-841-1602 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. To update your hospital designated point of contact, click here.
- 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 of the steps related to the hospital discharge appeals process, visit: http://www.hsag.com/App_Resources/Documents/CA_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/CA_Hospital_Appeals_FAQs.pdf.
To download all of the forms and instructions, please visit http://www.cms.gov/BNI/.
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For more information on appeals, visit http://www.hsag.com/caproviders/appeals.aspx |
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HSAG Contacts
Hospitals:
Tom Jackson, MBA, Executive Director, Medicare Operations, 818.641.4419
Elaine Krantzberg, RN, Project Director, Quality Data Reporting, 813-865-3420
Nursing Homes:
Jennifer Wieckowski, MSG, Manager, Nursing Home, 818.247.4378
Physician Offices:
Hector Cariello, MPH, Physician Office Project Manager, 602.665.6132
Case Review:
Marie Munch, MBA, Communication Coordinator, 813.354.9111
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