The Partnership for Patients and the Aging Network

Message from the Assistant Secretary for Aging Kathy Greenlee

Today, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national public-private partnership with the goals of:

* Keeping patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 

* Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

Through the Community-based Care Transition Program, HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help people with Medicare safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits. In addition, in coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. 

The aging network – state and local organizations alike -- has a vital role to play in this effort to integrate medical and long-term supports and services and improve care transitions for our clients and their families.  This work also provide an excellent opportunity to integrate other important work you are already doing – including Aging and Disability Resource Centers, benefits outreach and enrollment, caregiving and respite programs, chronic disease self-management and other health promotion/disease prevention programs, and more.  Finally, the partnerships that you build through care transitions work – with hospitals, physician practices, long-term care facilities and other organizations – can also help to position you better for future ACA-related opportunities such as accountable care organizations, health homes, patient-centered medical homes, and more.

Here is how we can work together on this initiative:

* Learn more about the Partnership for Patients and join the partnership by visiting the Partnership website at http://www.healthcare.gov/center/programs/partnership 

* Read our special Affordable Care Act Newsletter which provides you with additional details about the Partnership for Patients and the Community-based Care Transition Program (CCTP).  To access the newsletter, please go to  http://www.aoa.gov/Aging_Statistics/docs/ACA_Enews_P4P_041211.pdf 

* Join us for our next Webinar on Wednesday, April 20, which will offer an overview of the CCTP solicitation, and the opportunities for the aging network that lie within.  (Watch your email for registration details)    

Palliative Care Helps Quality of Life for Sick | The Daily Journal | thedailyjournal.com

Written by LIZ SZABO -USA Today

There are no secret passwords in medicine, no mysterious handshakes or signals to use when seeking the best care for a serious illness.

But experts say two words come close: palliative care.

Many people have never heard of palliative care, a comprehensive service that aims to relieve suffering in people with serious illnesses, such as cancer, lung disease or kidney failure.

Some patients and even many doctors confuse palliative medicine with hospice, a form of palliative care for people in the last six months of life. Other patients mistakenly worry that doctors won't work as hard to cure them if they ask for palliative care, says Gail Cooney, former president of the American Academy of Hospice and Palliative Medicine.

Those notions could change in light of recent research.
More

Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way" - The Commonwealth Fund

Authors: Sharon Silow-Carroll, M.B.A., M.S.W., and Jennifer N. Edwards, Dr.P.H.

Downloads-Case Study (1745K PDF)

Overview

McKay-Dee Hospital Center in Ogden, Utah, part of the Intermountain Healthcare System, had readmission rates in the lowest 3 percent of hospitals across the nation for all three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS) for the selection period, and its heart failure and pneumonia readmission rates were within the best 1 percent of hospitals reporting (Exhibit 1).
McKay-Dee’s success may be attributed to the following:

• comprehensive quality improvement strategies, supported by extensive, systemwide clinical research and training in evidence-based care;
• standardization of care through "care process models," or clinical protocols, and heavy use of hospitalists;
• information systems designed to monitor quality;
• interdisciplinary care coordination and discharge planning with individualized patient education and scheduling of follow-up appointments before discharge;
• comprehensive identification of heart disease patients for education, post-discharge phone calls, and referral to the outpatient heart failure clinic;
• integration with community providers, both within and outside of Intermountain's network, which provides a continuum of care and helps ensure patients are connected with a medical home; and
• Intermountain's role as a leader in health care delivery and payment innovations, exemplified in its involvement with pilots of bundled payment/accountable care arrangements.

The Intermountain Healthcare System is a highly integrated system with multiple hospitals, primary care practices and clinics, an outpatient heart clinic, home health service, and a renowned clinical research institute. Membership in this system provides clear advantages in terms of shared resources and expertise, and enhanced communication across care settings. Nevertheless, McKay-Dee's experiences provide lessons for other hospitals and systems—even less-integrated entities—that are striving to reduce readmission rates as well as improve outcomes and maximize systemwide efficiencies.

First, McKay-Dee Hospital Center and Intermountain Healthcare operate on the premise that lower readmission rates, better quality measure scores, and financial savings are not the primary focus of their efforts, but rather byproducts of caring for patients correctly. Second, alignment of hospital care with outpatient care improves transitions and health outcomes. Third, it is critical to select and nurture physician leaders who embrace a hospital's quality measurement and reporting philosophy. If other physicians do not respond through medical leadership and incentives, it may be necessary to hold them to a higher level of accountability to encourage their adherence to clinical protocols. Current payment policy that rewards volume rather than clinical outcomes conflicts with some of these desired practices. Over the long term, changes to the incentives in the health care system are needed to align goals across hospitals and other stakeholders.

---

This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

 

Citation

S. Silow-Carroll and J. N. Edwards, Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way," The Commonwealth Fund, Feb. 2011.

Memorial Hermann Memorial City Medical Center: Excellence in Heart Attack Care Reduces Readmissions - The Commonwealth Fund

Authors: Aimee Lashbrook, J.D., M.H.S.A., and Jennifer N. Edwards, Dr.P.H.

Downloads

• Case Study (755K PDF)

Overview

Memorial Hermann Memorial City Medical Center (Memorial City) achieved superior readmission rates in two of the three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS). Its readmission rate for patients with acute myocardial infarction (AMI) and pneumonia surpassed the best 10 percent of hospitals in the country for the selection period. Its readmission rate for heart failure was not as strong, outperforming the national average only by a narrow margin. (Exhibit 1)
Memorial City's achievement of low readmission rates for heart attack and pneumonia appears to be related to the Memorial Hermann Healthcare System's efforts to improve quality and patient safety for all patients. At each of the system's hospitals, staff have sought to provide high-quality, safe care consistent with the highest clinical standards and to avoid problems such as infections or falls that can exacerbate patients' underlying health problems. Memorial City, in particular, has achieved exceptionally high standards in AMI care. They also have increased attention to educating and supporting patients and linking patients—even the uninsured—to needed care after discharge, which likely reduces readmissions.

Specifically, the following efforts and patient-focused interventions, which were initiated by the system and implemented at the hospital, seem to contribute to Memorial City's low readmission rates:
Organizational efforts

• Emphasis on quality, with a clear leadership vision that is communicated to all clinical staff and backed up by the commitment of needed resources. The health system aims to "do the right thing the first time."
• Concurrent review of performance on core measures during a patient's stay to monitor achievement of goals, with findings reported to physicians.
• Extensive employee training related to the system's top priorities to make sure everyone is "rowing in the right direction."

Patient-focused interventions

• Planning for discharge begins upon admission, with staff actively educating patients about their disease and connecting patients with a source of ongoing care, even if they lack insurance coverage. The hospital offers a community-based disease management program for uninsured patients with chronic illness.
• Risk-assessment software helps case managers establish the appropriate level of care and assess a patient’s readiness for discharge.
• Pharmacists are located in high-risk units to provide medication education to patients and help simplify home medication regimens.
• Iterative process improvements in AMI care have resulted in a lower door-to-balloon time, which preserves heart muscle, thus reducing complications and the risk of readmission. Memorial City’s average door-to-balloon time is around 65 minutes, compared with the Joint Commission's standard of 90 minutes.

Planning for discharge begins upon admission, with staff actively educating patients about their disease and connecting patients with a source of ongoing care, even if they lack insurance coverage. The hospital offers a community-based disease management program for uninsured patients with chronic illness.

---

This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

Citation

A. Lashbrook and J. N. Edwards, Memorial Hermann Memorial City Medical Center: Excellence in Heart Attack Care Reduces Readmissions, The Commonwealth Fund, Feb. 2011.

Gap Seen in Readmit Rates by Race, Location

By Michael Smith, North American Correspondent, MedPage Today

Older black patients admitted to hospital for three common conditions -- congestive heart failure, heart attack, or pneumonia -- are 13% more likely than whites to be readmitted within a month, researchers reported.

But the analysis of Medicare discharge data for more than three million patients, also found disparities related to where patients get care -- both blacks and whites treated at hospitals with a large proportion of black patients had even higher readmission rates, according to Karen Joynt, MD, PhD, of Brigham and Women's Hospital in Boston, and colleagues.

Overall, about one in five older patients admitted to the hospital with heart failure, MI, or pneumonia were readmitted within 30 days, Joynt and co-authors wrote in the Feb. 16 issue of the Journal of the American Medical Association.

Read More

FDA Airs Concerns About Hip Joints to Patients

Image via Wikipedia
By John Gever, Senior Editor, MedPage Today

Metal-on-metal hip implants have disadvantages as well as advantages, according to the FDA, and the agency is making the case directly to patients on its website.

In a set of web pages unveiled Thursday, the FDA cited problems that can arise from the inevitable release of metal particles as patients flex their new joints. Adverse reactions in the bones in which the implant is embedded also occur in some patients.

"Metal-on-metal hip replacement systems have unique risks in addition to the general risks of all hip implant systems," the agency warned.
Full Article

Appointments AnnouncedTo Methodology Committee Of The Patient-Centered Outcomes Research Institute (PCORI)

Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of 15 members to the Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI).

 

“The Methodology Committee has the responsibility of helping PCORI develop and update methodological standards and guidance for comparative clinical effectiveness research.  The  men and women named today bring impressive credentials and experience to this important task,” Dodaro said.

 

The Patient Protection and Affordable Care Act authorized PCORI as a non-profit corporation to assist patients, clinicians, purchasers, and policymakers in making informed health decisions by providing quality, relevant evidence on how best to prevent, diagnose, treat, and monitor diseases and other health conditions.

 

The Act directs the Comptroller General to appoint up to 15 members to PCORI’s Methodology Committee.  In addition to the 15 members appointed today, the Director of the Agency for Healthcare Research and Quality and the Director of the National Institutes of Health, or their designees, will also serve on the committee.

 

The members appointed to the Methodology Committee are:

 

•     Naomi Aronson, PhD, Executive Director, Blue Cross and Blue Shield Association Technology Evaluation Center.

 

•     Ethan Basch, MD, MSc, medical oncologist and health services researcher, Department of Medicine and Department of Epidemiology, Memorial Sloan-Kettering Cancer Center.

 

•     Alfred Berg, MD, MPH, Professor, Department of Family Medicine, University of Washington.

 

•     David Flum, MD, MPH, Professor, Department of Surgery and Adjunct Professor, Department of Health Services, University of Washington Schools of Medicine and Public Health; Attending physician, General Surgery, University of Washington Medical Center.

 

•     Sherine Gabriel, MD, MSc, Professor of Medicine and of Epidemiology, and the William J. and Charles H. Mayo Professor, Mayo Clinic.

 

•     Steven Goodman, MD, PhD, Professor of Oncology, of Pediatrics, of Epidemiology and of Biostatistics, Johns Hopkins School of Medicine and Bloomberg School of Public Health. 

 

•     Mark Helfand, MD, MS, MPH, Professor of Medicine and of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University; Staff physician, Portland VA Medical Center.

 

•     John Ioannidis, MD, DSc, the C.F. Rehnborg Professor in Disease Prevention, Professor of Medicine and Director, Stanford Prevention Research Center, Stanford University School of Medicine. 

 

•     David Meltzer, MD, PhD,  Director, Center for Health and the Social Sciences, Chief of the Section of Hospital Medicine, and Associate Professor, Department of Medicine, Department of Economics, and Graduate School of Public Policy Studies, University of Chicago.

 

•     Brian Mittman, PhD, Director, VA Center for Implementation Practice and Research Support, Department of Veterans Affairs Greater Los Angeles Healthcare System. 

 

•     Robin Newhouse, PhD, RN, Assistant Dean, Doctor of Nursing Practice Program and Associate Professor, Organizational Systems and Adult Health, University of Maryland School of Nursing. 

 

•     Sharon-Lise Normand, MSc, PhD, Professor of Health Care Policy, Harvard Medical School and Professor of Biostatistics, Harvard School of Public Health. 

 

•     Sebastian Schneeweiss, MD, ScD, Associate Professor, Department of Medicine, Harvard Medical School and Associate Professor, Department of Epidemiology, Harvard School of Public Health;  Vice Chief and Director,  Drug Evaluation and Outcomes Research, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital.

 

•     Mary Tinetti, MD, Professor of Medicine, Epidemiology, and Public Health, Division of Geriatrics, Yale University School of Medicine;  Director, Program on Aging, Yale University School of Medicine.

 

•     Clyde Yancy, MD, MSc, Chief, Cardiology, Northwestern University Feinberg School of Medicine; Associate Director, The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital.

 

 

Attached are brief biographies of the new committee members. The official announcement of the appointments will be published in the Federal Register. For more information, contact Mary Giffin of GAO's Health Care team at (202) 512-7114 or Chuck Young in GAO's Office of Public Affairs at (202) 512-4800, or visit the GAO Health Care Advisory Committees web page at http://www.gao.gov/about/hcac/index.html. The Act requires the Comptroller General to disclose any conflicts of interest in appointing members of the Methodology Committee on GAO’s website. Please click here (http://www.gao.gov/about/hcac/pcori_methodology_comm_conflicts.html) for more information.

 

The Comptroller General is required to disclose any conflicts of interest on GAO’s website. Please click here (http://www.gao.gov/about/hcac/pcori_methodology_comm_conflicts.html) for a list of the Methodology Committee members’ associations the Comptroller General has determined fit within the Act’s definition of a “conflict of interest.”

Prescription Drug Containers May Get Simpler Labels... American Medical News

Image via Wikipedia
By Kevin B. O'Reilly, amednews staff

Nearly half of patients misunderstand dosage instructions on prescription container labels, and more than half do not comprehend the warnings on those labels, according to different studies. For years, medical experts have advocated for simpler labels to help patients take their medications as intended.

Labeling standards proposed in January by the influential U.S. Pharmacopeial Convention could make those recommendations a reality.

USP's proposal says that, when creating prescription labels, pharmacies should:

• Emphasize the most important information at the top, such as the patient's name, drug name, drug strength and instructions.
• Steer clear of Latin terms; use simple, concise language; and make instructions more explicit. For example, labels should say "Take 2 tablets in the morning and in the evening," instead of "Take two tablets twice daily."
• Format labels with a large font size, the equivalent of 12-point Times New Roman or bigger, and use black print on a white background.
• Use normal punctuation, provide enough white space between lines of text and have text run only horizontally on the label.

In addition, the proposed standards say pharmacies should include the medication's purpose, with patient permission, using familiar terms -- "for high blood pressure," not "for hypertension." Labeling should be provided in the patient's preferred language when possible, using high-quality translation tools.
Full Article

The End Of Internal Medicine As We Know It – Health Affairs Blog

by Caroline Poplin

Physicians have doubtless been issuing jeremiads since before Jeremiah. We are overworked, underpaid, and underappreciated.

But today, general internists have a real problem. And it is our leaders who do this to us. As summarized in the Annals of Internal Medicine:

To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups. The most successful physicians will be those who collaborate with other providers to improve outcomes, care productivity and patient experience.

In the future envisioned by the health policy community, including the leadership of the Amercian College of Physicians and the American Medical Association, patients who want a personal physician, someone they know and trust, who understands and cares about them as individuals will have to pay extra for “concierge” care. Everyone else will migrate to team care from large “Accountable Care Oranizations” (accountable to whom, one may ask—certainly not the patients). These teams may well improve patients’ blood pressures, glucose control, lipid panels, maybe even weight, and indeed improve the outcomes of patients whose outcomes can be improved. Their care will be efficient: providers (yes, providers) who do not see enough patients, whose patients do not improve adequately, who order too many tests, do not meet the fifteen criteria for meaningful use of EHRs, or do not continuously pursue quality improvement projects, will see their incomes fall.

Perhaps the new organizations will provide better care for some patients and some conditions. Will other patients — those with poor prognoses, bad attitudes, complex or ill-defined diagnoses, multiple complications, cognitive limitations, even just morbid obesity — be lost in the shuffle.

And whether this radical overhaul of the health care delivery system will reduce health care costs overall, ostensibly the point of the exercise, is unknown. The cost of multiple layers of highly paid managers (including multi-million dollar executives) and the extensive information technology infrastructure on which these elaborate systems depend, is not trivial. Indeed, modern industry abandoned command-and-control style vertical integration decades ago in favor of flatter, more nimble institutions that pay serious attention to suggestions from production workers and those who deal directly with customers. What little evidence we have on cost savings from ACOs is largely anecdotal and equivocal.
Continue Reading

Can Good Care Produce Bad Health?

Excerpts from the Amy Berman post on the John A. Hartford Foundation blog

For those of you who haven’t yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was.

My recent journey through the health care system has been eye-opening. In only a few months, I have witnessed the remarkable capabilities and the stunning shortcomings of our health care system firsthand. I am writing here because in the time I have left, I hope my story and my journey can help illustrate why some of the reforms that my colleagues and I at the John A. Hartford Foundation, as well as many others, have championed are so important.

. . .

Based on a perverse set of metrics, the Philadelphia oncologist was offering technically the “best” care America had to offer. Yet this good care was not best for me. It wouldn’t give me health. Instead, it might take away what health I had. It doesn’t matter if care is cutting-edge and technologically advanced; if it doesn’t take the patient’s goals into account, it may not be worth doing.

. . .

I was determined not only to choose treatment that would maximize the healthy time I had remaining, but also to use that time to call on our health care institutions and professionals to make a real commitment to listening to their patients. In the health policy field, we call this patient-centered care. As a nurse and a senior program officer at a health care foundation, I understood my disease and my health care options well enough to make an informed decision about my treatment.

What about the millions of older Americans facing a terminal illness or chronic disease? How can they possibly stand up to the juggernaut of our health system and say, “No. I want care that focuses on my goals, care that is centered on me.” We need to make it easier for everyone to obtain care that fits their health care goals. How can we change the system and the measurement of quality to place the patient at the center? I call on everyone involved in health care practice and reform efforts to give serious thought about how we can reorient our health care system toward patient-centered care.

Read the full post at The John A. Hartford Foundation blog

Partnership Takes Aim At Preventable Hospital Readmissions Among High-Risk Seniors

SCAN Health Plan and Lakewood IPA have partnered with Dovetail Health in a program designed to reduce readmission rates for high-risk seniors following discharge from hospitals and skilled nursing facilities.

Under the new program, high-risk SCAN Health Plan members in Southern California whose primary care physicians are part of Lakewood IPA are now being referred into Lakewood's "Healthy Transitions" program upon discharge. Led by Dovetail, the Healthy Transitions program combines elements of existing transition management programs - such as improved discharge planning and telephonic case management - with a unique focus on medication optimization and adherence.

"We believe that this program will lessen the number of seniors readmitted to a hospital for reasons that are totally avoidable," said Timothy Schwab, MD, chief medical officer for the not-for-profit SCAN Health Plan. "By focusing on those problems most commonly found and tailoring the program to each individual, we can make a significant, positive impact in the lives of many of our members."

In general, patients enrolled in the program take an average of 12 medications and have chronic conditions such as diabetes, chronic obstructive pulmonary disease, congestive heart failure and renal disease. More than 75 percent are at increased risk of falls. One in five seniors nationwide is readmitted within 30 days of discharge at a staggering cost of over $17 billion, and medication-related issues are frequently a factor.

The Healthy Transitions program sends pharmacists to meet patients in their homes following discharge from hospitals and skilled nursing facilities. Healthy Transitions pharmacists review every prescription and over-the-counter medication. During the visits they clarify orders, educate patients and caregivers, identify opportunities to optimize medication schedules, and address issues such as non-adherence. Easy-to-read reports are printed for patients, and a version is prepared for their physicians with key questions or issues highlighted.

In addition to medication counseling and support, the Healthy Transitions program follows patients for 30 days to provide ongoing guidance around chronic illnesses, safety, advance-care planning and other potential readmission risk factors. At the end of 30 days, patients are referred back into the appropriate care-management programs at SCAN or Lakewood IPA.

"Our patients have been very open to having the home visit. The comprehensive counseling, support and assessment from the pharmacist are an asset to the physician and the case managers in the continued coordination of care for these high-risk members," said Robin Tufono, director of outreach programs at Coast.

Full Article