| CA Hospital Inpatient Quality Reporting | |
| CA Annual Medical Services Review Report | |
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Summer 2010 California Edition: Volume 1, Issue 2 |
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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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"Helping Leaders Blink Correctly" Parts I and II
A recent two-part article in the May/June and July/August 2010 issues of Healthcare Executive features the Institute for Healthcare Improvement’s (IHI’s) Executive Director of Performance Improvement, Robert Lloyd, PhD, as he describes the necessary skills health care leaders need to develop in order to "blink" appropriately. Highlights include understanding the messiness of improving health care, determining why they are measuring, understanding and depicting variation, and translating data into information. Learn how split-second decisions have patient safety implications and understand how variation in data can help leaders make appropriate decisions. Without these skills, Dr. Lloyd argues, we run the risk of going off in the wrong direction in the "blink of an eye." To read the two-part article, visit http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/Leadership/
Literature/HelpingLeadersBlinkCorrectlyPart1.htm (Part I) and
http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/
Leadership/Literature/HelpingLeadersBlinkCorrectlyPart2.htm (Part II).
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Chasing Zero: Winning the War on Healthcare Harm
Chasing Zero: Winning the War on Healthcare Harm is a 55-minute documentary produced by actor Dennis Quaid and the Texas Medical Institute of Technology (TMIT) to raise awareness on the risks of medical errors and efforts needed to improve patient safety. This documentary is available for viewing at http://discoveryhealthcme.discovery.com/zero/zero.html.
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 Preventing HF Readmissions: Is Your Organization Prepared?
An article in the June 2010 Nursing Economics: The Journal for Health Care Leaders, titled "Preventing Heart Failure (HF) Readmissions: Is Your Organization Prepared?" discusses hospital and health care systems' focus on improving performance and patient outcomes, with a particular emphasis on how the management of HF can prevent readmissions, decrease the cost per case, and improve the quality and satisfaction for this patient population. The article describes health care reform in relation to HF readmissions, strategies to reduce HF readmissions, proper transitions home, a process for executing HF readmission reduction strategies, and improving patient care and preparing for the future . . . today. A process for HF program assessment and implementation is also discussed. To read the entire article, visit http://www.medscape.com/viewarticle/722234.
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HAI Public Reporting
According to Centers for Disease Control and Prevention (CDC), healthcare-associated infections (HAIs) are the most common complication of hospital care, and four specific infections account for more than 80 percent of all HAIs: surgical site infections (SSIs), catheter-associated urinary tract infections (CAUTIs), central venous catheter-related blood stream infections (CRBSIs), and ventilator associated pneumonia (VAP). The large burden of disease posed by HAIs has prompted regulatory attention and monitoring and legislating public reporting of HAIs. In California, Senate Bill 1058, passed in 2008, requires California hospitals to report new infections to the California Department of Public Health (CDPH). Those infection rates will be published on the state agency’s Web site in January 2011. To view the CDPH HAIs Plan, visit http://www.cdph.ca.gov/services/boards/Documents/CDPHHAIPlan.pdf.
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HSPSC 2010 User Comparative Database Report
The Agency for Healthcare Research and Quality (AHRQ) has released the Hospital Survey on Patient Safety Culture (HSPSC) 2010 User Comparative Database Report. The initial results contained in this report are based on data from almost 900 U.S. hospitals that took part in the baseline HSPSC. Hospitals can use information in the report to compare their patient safety culture to other U.S. hospitals. The report also contains survey administration statistics, characteristics of participating hospitals and respondents, overall results, comparison results, trending, action planning for improvement references, descriptions of data calculation, tables, and charts. The HSPSC 2010 User Comparative Database Report can be accessed at http://www.ahrq.gov/qual/hospsurvey10.
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WHO’s Global Patient Safety Challenge
"SAVE LIVES: Clean Your Hands" is a global patient safety challenge led by the World Health Organization (WHO) to improve hand hygiene at the point of patient care and prevent HAIs. On May 5, 2010, the WHO issued a global call to action inviting health care facilities and organizations worldwide to register and make observations using the WHO Hand Hygiene Moment 1—Global Observation Survey, a validated assessment tool to assess hand hygiene promotion and practices in health care facilities. To date, there are 11,915 registered health care facilities in 141 countries committed to this campaign. For more details, visit http://www.who.int/gpsc/5may/en.
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My 5 Moments for Hand Hygiene
My 5 Moments for Hand Hygiene is an evidence-based approach to hand hygiene developed by the WHO that defines the key moments when health care workers should perform hand hygiene. Practical tools and resources—including WHO guidelines, posters, implementation guides, and other downloads—are available for health care organizations to implement procedures and monitor compliance. For more information on the 5 Moments Hand Hygiene approach, visit http://www.who.int/gpsc/5may/background/5moments/en/index.html.
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How to Contact RHQDAPU Representatives
The HSAG of California Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Team provides program education and technical assistance to California hospitals through multiple outreach activities. The team hosts quarterly Webinars to provide education on program changes, specification measure changes, and tips for effective abstraction. The RHQDAPU 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. In addition, a RHQDAPU e-mail list is available for hospitals to join. Through this list, hospitals will receive updates on clinical measures, the Specification Manual, data collection, submission, and public reporting requirements.
To join the HSAG RHQDAPU e-mail list, visit http://www.hsag.com/caproviders/rhqdapu.aspx.
The next recorded "In The Know" WebEx will be available July 28 at http://www.hsag.com/caproviders/events.aspx.
To view other recorded Webinars, tools and tip sheets, visit http://www.hsag.com/caproviders/events.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 then listed by state.
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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 of California is the Advancing Excellence Local Area Network for Excellence (LANE) convener in California 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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Governor Schwarzenegger Announces New Governance Entity to Advance Health Information Exchange in California with Stimulus Funding
Governor Schwarzenegger and California Health and Human Services Agency (CHHS) Secretary Kim Belshe announced the state’s intent to name Cal eConnect as a new nonprofit entity that will provide leadership and oversee a collaborative process to develop and support Health Information Exchange (HIE) services in California. To view the full press release, visit http://www.ehealth.ca.gov/LinkClick.aspx?fileticket=frz7p75LzqI%3d&tabid=84.
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 Hospital Discharge Appeals
When issuing the Important Message from Medicare (IM), facilities should keep in mind that the IM must be given to a competent beneficiary. If there is doubt about a beneficiary’s competency, the issuer should ask himself or herself, "Is this beneficiary able to exercise his or her right to an appeal?" "Can the beneficiary understand the notice, dial the telephone, and explain his or her point of view in a cogent manner?" If the answer to any of these questions is "maybe" or "no," then the issuer should choose an alternative method of valid delivery of the IM, such as assisting the beneficiary in calling the Quality Improvement Organization (QIO—HSAG of California is the state’s QIO) to start the appeal process. If the beneficiary has a health care surrogate or a power of attorney and there is doubt regarding the beneficiary’s competency, issue the IM to the beneficiary’s representative. If a beneficiary is competent, then the beneficiary should receive the IM regardless of health care surrogacy or power of attorney status.
If there is no health care surrogate or power of attorney and there is a question about the beneficiary’s competency, the issuer can, with the assistance of risk management personnel, seek a neutral party to act on the beneficiary’s behalf. In this case, the IM cannot be given to the beneficiary. If there is no neutral party, the IM should not be issued. If a health care surrogate or power of attorney has been identified, and he or she has been issued the IM, only that person should contact the QIO to begin the appeals process. QIO personnel will only speak with the person who calls for the appeal. Communication with individuals other than the health care surrogate, power of attorney, or appointed representative could lead to questions of HIPAA violations. In instances in which family members are in dispute with the power of attorney, the matter should be resolved privately without QIO involvement.
For questions regarding issuing the IM, please contact HSAG of California at 1.866.800.8750 or visithttp://www.hsag.com/caproviders/appeals.aspx.
For more information on appeals, visit http://www.hsag.com/caproviders/appeals.aspx |
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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:
Darla Farrell, RN, MBA, FACHE, CPHQ, Director, Hosptial Patient Safety, 818.433.2190
Elaine Krantzberg, RN, Project Director, Quality Data Reporting, 813-865-3420
Nursing Homes:
Jennifer Wieckowski, MSG, Director, Nursing Home, Patient Safety, 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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