| CA Hospital Inpatient Quality Reporting | |
| CA Annual Medical Services Review Report | |
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Summer 2011 California Edition: Volume 2, Issue 2 |
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 New CMS Quality Improvement Projects to Begin August 1
The Centers for Medicare & Medicaid Services (CMS) utilizes its network of state-based Quality Improvement Organizations (QIOs—HSAG is the QIO for California) to protect Medicare beneficiaries, assist health care providers, and improve the U.S. health care system. It does this through the implementation of three-year cycles of work that define specific national health care quality improvement projects that the QIO network implements at the local level. A new cycle (the 10th Scope of Work) begins August 1, 2011.
The 10th Scope of Work is in alignment with the recently developed U.S. Department of Health and Human Services (HHS) National Strategy for Quality Improvement in Health Care (National Quality Strategy), which has three broad aims of (1) better health care, (2) better health for people and communities, and (3) affordable care through lowering cost by improvement. QIOs will assist local health care providers to improve in the following areas:
- Hospitals—Reducing Healthcare-Associated Infections
- Central-Line Associated Bloodstream Infections (CLABSIs)
- Catheter-Associated Urinary Tract Infections (CAUTIs)
- Surgical Site Infections (SSIs)
- Clostridium Difficile Infections (CDIs)
- Nursing Homes—Reducing Healthcare-Acquired Conditions
- Pressure Ulcers
- Physical Restraints
- CAUTIs
- Falls
- Physician Offices—Using Electronic Health Records to Improve Primary Care Prevention and Early Diagnosis
- Flu and Pneumonia Immunization
- Breast and Colorectal Cancer Screening
- Ischemic Vascular Disease
- All Providers—Reducing Adverse Drug Events and Implementing Patient-Centered Care
- All Providers—Improving Care Transitions
Beginning in August, HSAG will invite local providers to participate in the above-named quality improvement activities. At that time, more information will be available at www.hsag.com.
For more about the CMS QIO program, visit http://www.cms.gov/QualityImprovementOrgs.
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 Twelve California Hospitals Fined for Patient Harm and Deaths
Twelve California hospitals were fined a total of $650,000 for medication overdose errors, preventable falls, and other lapses in care that resulted in patient harm and death. Errors for which hospitals were sanctioned include an incident in which a 62-year-old woman died after a registered nurse reprogrammed her IV pump to deliver 100 milliliters per hour of morphine instead of 3 milliliters per hour. At another hospital, a patient with a history of confusion and agitation died after falling and fracturing his skull.
Pam Dickfoss, acting deputy director of the Center for Health Care Quality, California Department of Public Health, said hospitals are still incorporating reporting of these events into their protocols and procedures and "are educating their staff on adverse events," as reported on HealthMediaLeaders.com. Dickfoss expects that penalties will continue to be imposed and will even peak at some point before they begin to decline when more safety precautions are put in place. Learn more here.
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Nurses Key to Cutting Readmissions
Nurses providing transitional care can improve outcomes and reduce hospital readmissions for elderly patients, according to a study conducted by the University of Pennsylvania School of Nursing. The study shows that successful transitional care programs use nurses, often with master's degrees, who work with patients, family caregivers, and health teams to prevent medical errors and ensure continuity of care as patients navigate a fragmented care system. Learn more here.
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Hospital Inpatient Quality Reporting Program
The HSAG of California Hospital Inpatient Quality Reporting (IQR) Program (formerly known as Reporting Hospital Quality Data for Annual Payment Update—RHQDAPU) Team helps California hospitals meet requirements for inpatient quality reporting. The Hospital IQR Program Team assists hospitals in the following areas:
- Abstraction of the National Inpatient Measure Sets
- Inpatient data reporting requirements
- Inpatient data validation
- QualityNet registrations
- The use of CART (CMS Abstraction and Reporting Tool)
HSAG of California's IQR Team uses the IQR E-mail List to rapidly communicate critical information to hospitals. To sign up for the List, visit http://lists.flqio.org/mailman/listinfo/rhqdapufl-ca.
An additional SHHEO (Small Hospitals Helping Each Other) E-mail List serves as a networking resource that allows smaller hospitals to post questions and comments and help each other when limited support is present within their own organizations. This list can help with:
- Identification of initial patient populations for abstraction and reporting.
- Initial CART setup including hospital information, users, and measures.
- Exporting and uploading data from CART.
- Running reports in CART.
- CART troubleshooting.
- Other quality improvement processes.
The list is moderated by HSAG of California Hospital IQR Program project coordinators. To subscribe, visit http://lists.flqio.org/mailman/listinfo/shheo-fl-ca.
HSAG of California’s Hospital IQR team also provides prerecorded quarterly Webinars and posts them on the HSAG Web site. The most recent prerecorded Webinar, from July 28, 2011, covers administrative updates and special information for abstractors. For more information, visit http://www.hsag.com/caproviders/events.aspx.
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Hospital Events and Resources
Southern California Patient Safety Collaborative (SCPSC)
Track I—Hospital-Acquired Infections in the ICU Setting, Sepsis, and SCIP
August 9, 2011
Track II—Pressure Ulcer Cross-Setting Collaborative
September 13, 2011
For more information on all 2011 SCPSC events, visit www.hsag.com/cahospitals/scpsc.aspx.
Important Dates
- Fiscal Year 2012 Structural Measures and Data Accuracy and Completeness Acknowledgement requirements are due August 15, 2011 (available from July 1–August 15, 2011).
- Q1 2011 Population and Sampling is due August 1, 2011.
- Q1 2011 Inpatient Clinical Data Submission is due August 15, 2011.
For more information on HSAG of California's hospital initiatives, visit http://www.hsag.com/cahospitals/default.aspx.
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 Resident-on-Resident Bullying a Challenging Issue
Nursing homes and assisted-living communities are challenged by the phenomenon of resident-on-resident bullying, according to a recent article at SeniorHomes.com. Bullying behaviors include excluding others from activities, monopolizing public areas, and using insulting comments. Residents who are bullied can experience anxiety, depression, and social isolation as a result.
Nursing home bullying is receiving increased attention, with recent stories in the New York Times, ABC News, and the Huffington Post addressing the issue.
There is little research on resident-to-resident bullying and, at present, there are no generally agreed upon guidelines to address the behavior. A sudden increase in bullying behavior, especially if it’s uncharacteristic for the resident, should be an indication to the facility’s staff members that there may be an underlying medical cause, such as Alzheimer’s disease, that requires evaluation. To learn more, visit http://www.seniorhomes.com/w/tag/nursing-home-bullying.
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Black Nursing Home Residents More Likely to Develop Pressure Ulcers than White Residents, Study Says
Black residents in nursing homes consistently have higher rates of pressure ulcers than white residents, according to a study published in the Journal of the American Medical Association. The rate among blacks was 14.6 percent in 2008, as compared with 9.6 percent among whites.
The highest rate of bed sores in 2008 (15.5 percent) occurred among black residents in nursing homes with the highest concentrations of black residents. The lowest rate (8.8 percent) was among white residents in nursing homes with the lowest concentrations of black residents. Residents of both races in nursing homes with the highest concentrations of black residents were at least 30 percent more likely to develop bed sores than residents in nursing homes with few or no black residents.
Nursing homes with higher concentrations of black residents tended to have lower staffing levels of registered nurses and certified nurse assistants and to be larger for-profit and urban facilities. "These facilities may be more financially disadvantaged when caring for patients predominantly receiving Medicaid," the study authors write.
For more information, visit http://pubs.ama-assn.org/homepage/media/2011j/0712.dtl#4.
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CMS Issues Guidance on Same-Sex Couples in Nursing Homes
The Centers for Medicare & Medicaid Services (CMS) has issued a new directive that grants states the flexibility to extend the same protections of assets and finances to same-sex couples as heterosexual couples when one member receives nursing home care financed by Medicaid. For example, a member of a same-sex couple is allowed to remain in the pair's home when a same-sex spouse or domestic partner enters a nursing home.
Twelve states, including California and the District of Columbia, currently offer same-sex marriage or civil union arrangements and are expected to adopt policies under this directive. An additional three states offer more limited domestic partnerships, but could also adopt new policies. Learn more here.
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 New, Shorter Version of CRC Screening Clinician's Toolbox and Guide Available
A new, shorter version of the Colorectal Cancer (CRC) Screening Clinician’s Toolbox and Guide is now available. The most important material from the full Guide was condensed into a step-by-step tool that still offers an expansive collection of the most relevant charts, templates, and sample materials that clinicians can put to use. View the Guide by visiting http://nccrt.org/about/provider-education/crc-clinician-guide.
For a copy of the presentation that accompanies the Guide, visit http://nccrt.org/wp-content/uploads/CancerScreeningActionPlan.pdf.
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Medicare Beneficiaries Not Taking Full Advantage of Preventive Services
As part of the new federal health care law, Medicare beneficiaries have access to more than a dozen free tests and other services to prevent or control cancer and other debilitating diseases, but many are not taking advantage of preventive services such as mammograms or colonoscopies. Download the Medicare & You Handbook, which includes a list of preventive services that are now free.
For more information, visit http://tinyurl.com/647sbku.
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CMS Announces First Medicare EHR Incentive Payments
On May 19, 2011, the Medicare Electronic Health Record (EHR) Incentive Program issued the first round of payments totaling $75 million to providers who signed up in the first two weeks of the program. The Centers for Medicare & Medicaid Services (CMS) expects that providers will attest throughout 2011 and that the total amount of Medicare EHR incentive payments will continue to grow. For more information on the Medicare and Medicaid EHR Incentive Programs, visit http://www.cms.gov/ehrincentiveprograms.
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CMS Announces Proposed Rule for the Electronic Prescribing (eRx) Incentive Program
CMS has proposed changes to the Medicare eRx Incentive Program due to requests to better align the Program with the Medicare and Medicaid EHR Incentive Programs.
The CMS proposed eRx rule may be viewed at http://www.gpo.gov/fdsys/pkg/FR-2011-06-01/pdf/2011-13463.pdf.
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 OIG Work Plan
The Office of Inspector General (OIG) Work Plan for Fiscal Year 2011 provides descriptions of activities that the OIG plans to initiate or continue with respect to programs and operations of the Department of Health and Human Services in fiscal year 2011. The body of the Work Plan is presented in seven major parts followed by Appendix A, which describes the OIG’s oversight and funding that HHS receives under the American Recovery and Reinvestment Act of 2009. The seven major parts of the Work Plan include:
- Medicare Part A and Part B.
- Medicare Part C and Part D.
- Medicaid Reviews.
- Legal and Investigative Activities.
- Public Health Reviews.
- Human Services Reviews.
- Department-Wide Issues.
For more information, visit http://oig.hhs.gov/publications/workplan/2011/.
To dowload the entire OIG Work Plan for Fiscal Year 2011, visit http://oig.hhs.gov/publications/workplan/2011/FY11_WorkPlan-All.pdf.
For more information on appeals, visit http://www.hsag.com/caproviders/appeals.aspx. |
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 FDA Reports Medication Errors Involving Requip and Risperdal
The Food and Drug Administration (FDA) has issued an alert on medication errors for patients who were given the antipsychotic risperidone (brand name Risperdal), instead of ropinirole (Requip), which is used to treat Parkinson’s disease and restless legs syndrome, or vice versa.
Some patients who took the wrong medication were hospitalized with symptoms that included confusion, lethargy, hallucinations, tiredness, dizziness, tingling, numbness, and altered mental status.
The FDA is asking medication manufacturers to take the following measures to reduce the potential for confusion between the two products:
- Use of "tall man" lettering on container labels and carton packaging to present the generic names as risperiDONE and rOPINIRole
- Changing labels and carton packaging to provide better differentiation between the products
To learn more, click here.
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HSAG Contacts
Hospitals:
Darla Farrell, RN, MBA, FACHE, CPHQ, Director, Hosptial Patient Safety, 818.265.4670
Elaine Krantzberg, RN, Project Director, Quality Data Reporting, 813.865.3420
Nursing Homes:
Jennifer Wieckowski, MSG, Director, Nursing Home, Patient Safety, 818.265.4640
Physician Offices:
Debashish Mittra, MBA, Director, Physician Office Quality, 818.265.4690
Case Review:
Marie Munch, MBA, Communication Coordinator, 813.354.9111
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We welcome your feedback! Please e-mail: arivera@hsag.com
This material was prepared by Health Services Advisory Group of California, Inc., the Medicare Quality Improvement Organization for California, 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. CA-9SOW-XC-072711-01.
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