Eden Moves HQ to New York « ChangingAging.org

by Dr. Bill Thomas

The Eden Alternative is moving its headquarters from Texas to Rochester, NY. Kudos to new Eden CEO Christopher Perna. And double kudos to the Rochester Biz Journal for posting an in depth report on Eden’s move and central role in the culture change movement: Read More

U.S. GAO - Medicare: CMS Needs to Collect Consistent Information from Quality Improvement Organizations to Strengthen Its Establishment of Budgets for Quality of Care Reviews

Full Report (PDF, 24 pages) Accessible Text Recommendations (HTML)

Summary

Medicare funds health care services for more than 46 million beneficiaries. The Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--contracts with private organizations known as Quality Improvement Organizations (QIO) to, among other core functions, improve the quality of care for Medicare beneficiaries. CMS contracts with one QIO for each of the 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. One of the QIOs' many responsibilities is to review quality of care concerns, raised by Medicare beneficiaries or others, to determine whether Medicare-financed medical services meet professionally recognized standards of health care. Quality of care reviews may address a range of issues, such as inappropriate treatment or hospital staff not administering medications on time; may involve a variety of health care services and settings; and may include a range of Medicare providers or practitioners. CMS enters into 3-year contracts with QIOs for a range of activities and reviews, including quality of care reviews. For each QIO contract, CMS establishes a budget reflecting the estimated costs of these activities and reviews. For the most recent contracts, which cover August 1, 2008, through July 31, 2011, CMS's budgets for the QIOs totaled about $1.1 billion, with approximately $208 million for all types of reviews, including QIOs' quality of care reviews, as well as some other activities. Questions have been raised about CMS's ability to set budgets appropriately for QIOs' quality of care reviews. A 2006 report by the Institute of Medicine (IOM) and a 2008 internal report commissioned by CMS identified weaknesses in CMS's ability to accurately compare costs across QIOs. Based on reports of wide variation in the costs that QIOs report for conducting these reviews, Congress raised questions about how CMS establishes QIOs' budgets. Ensuring that QIOs' budgets are based on accurate information is particularly important because CMS's contracts with the QIOs are funded from the Medicare Trust Funds, which are primarily used to support inpatient and outpatient health care services for Medicare beneficiaries. QIO contracts are funded from the Medicare Trust Funds in proportions from each that CMS determines to be fair and equitable, and the QIO program is not subject to the same kind of congressional oversight as other CMS programs, which are funded through the annual appropriations process. Policymakers are concerned about the long-term solvency of these Trust Funds and thus their ability to fund health care services for Medicare beneficiaries in the future. Congress raised questions about the information QIOs report to CMS for budgeting purposes and how CMS uses this information. To assist congressional consideration of this matter, this report describes and assesses the information CMS uses to establish the portion of QIOs' budgets for quality of care reviews.

To help establish QIOs' budgets for quality of care reviews for the current contract, the 9th Statement of Work, CMS used information that QIOs are required to provide to the agency about the volume of QIOs' quality of care reviews and the costs associated with conducting these reviews. CMS requires the QIOs to record information about the volume of their quality of care reviews in CMS's Case Review Information System (CRIS) and to record information about their labor costs in CMS's Financial Information and Vouchering System (FIVS). However, CMS has not established clear instructions for how QIOs should record volume and cost information in these systems. We found inconsistencies among some QIOs in the ways they record certain volume and cost information in CRIS and FIVS. As a result, the historical quality of care review volume and cost information CMS obtains is inconsistent across QIOs and CMS cannot be assured that the budgets it establishes for QIOs' quality of care reviews are appropriate.


Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director:	Kathleen M. King
Team:	Government Accountability Office: Health Care
Phone:	No phone on record

Recommendations for Executive Action

Recommendation: To ensure that QIOs consistently record volume and cost information for their quality of care reviews and to help ensure that the budgets CMS establishes for these reviews are appropriate, the Administrator of CMS should develop clear instructions specifying how QIOs should record information about the volume and costs of their quality of care reviews in CRIS and FIVS.

Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

Status: In process

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

In Oregon, Elder Sleuths Size Up Local Businesses

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by Paula Spann


Elders in Action, a nonprofit advocacy group in Portland, Ore., publishes an extensive directory of local businesses certified, after unannounced visits by undercover volunteers in their 60s through 80s, to be elder-friendly.

Take a look. Auto dealerships, medical practices, moving companies, food markets, travel agents, insurance firms, government agencies — the Elder Friendly Business Certification program has given a literal seal of approval to nearly 300 Portland-area locations.

It works this way: a local company, possibly noticing the surge in the older population and how much financial clout elders have, requests certification. Small businesses pay $200, larger ones $400. (Brief digression: What causes so many innovative concepts in aging, including assisted living, to originate in Oregon? And can we bottle it?)

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Consumer Reports Is Rating Heart Bypass Surgical Groups - NYTimes.com

Image via CrunchBaseby Denise Grady
Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.


In most parts of the country, data-based ratings of doctors are not available to patients. Only a few states, including New York, provide them.

The magazine published ratings of 221 surgical groups from 42 states online on Tuesday and will print them in its October issue. Groups are rated, not individual doctors. The groups receive one, two or three stars, for below average, average or above average. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery.

For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine. But within a few months, the ratings should be posted and freely available to the public at the Web site of the Society of Thoracic Surgeons (www.sts.org/), said Dr. Fred H. Edwards, the chairman of quality and research for the society, and medical director for cardiothoracic surgery at the University of Florida in Jacksonville. The society, which has been tracking surgeons’ performance since 1989, gave the information to Consumer Reports. More than 90 percent of the nation’s heart surgery programs participate in the society’s registry.
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Proposed Rule: Civil Money Penalties for Nursing Homes

This proposed rule would revise and expand current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in compliance with Federal participation requirements in accordance with the Patient Protection and Affordable Care Act of 2010.

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. EST on August 11,2010.

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Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care

Although health care spending per capita in the United States is more than double that of other industrialized nations, the United States ranks comparatively low on key indicators of the quality of care and population health status. Inefficiencies such as duplicate tests and widespread regional practice variations plague the system. Performance measurement is essential to system transformation. To provide guidance to key stakeholder groups in accelerating toward a high-performing, high-value healthcare system, the National Quality Forum (NQF) convened a Steering Committee to develop a framework for evaluating the efficiency of care over time, including clear definitions and a shared vision of what can be achieved around quality, cost, and value, serving as a foundation for the work of larger performance improvement efforts. This report presents the NQF-endorsed® measurement framework for assessing efficiency, and ultimately value, associated with the care over the course of an episode of illness and sets forth a vision to guide ongoing and future efforts.

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Ranking Health by County | Gooznews

by GoozNews

The Robert Wood Foundation has created a useful tool for health researchers: a ranking of counties across the country for health status, access to care, and quality of care. Not surprisingly:

People who live in healthier counties tend to have higher education levels, are more likely to be employed, have access to more health care providers, and have more access to healthier foods, parks and recreational facilities.

In addition, the Rankings show sharp health disparities even in counties located right next to each other. For example, someone living in Chester County, Pennsylvania, which ranked highest in the state for overall health, has a better shot at staying healthy than a resident of nearby Delaware County, which ranked 36th out of 67 and has higher rates of smoking, adult obesity and violent crime, and higher numbers of children living in poverty.

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Healthcare Economist · Did pay-for-performance work in the UK?

A paper by Sutton, Elder Guthrie and Watt (2010) describes the UK’s National Health Service’s (NHS) adoption of the Quality and Outcomes Framework (QOF) in April 2004. In general, P4P programs can have positive or negative spillovers. An example of a positive spillover would be the adoption of EMR to comply with certain P4P initiatives, but which also improves productivity in other areas. A negative spillover would occur if physicians focus on getting the P4P bonuses, but decrease effort in unmeasured areas which could be more important to the patient’s health.
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Hispanic Elderly More Likely Than Whites To Live In Inferior Nursing Homes

from Medical News Today

Hispanic senior citizens are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University.
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• Hispanic elderly more likely than whites to live in inferior nursing homes (scienceblog.com)

Potentially preventable hospitalization rates fall among elderly - FierceHealthcare

By Anne Zieger

At least for some conditions, the rate of potentially preventable hospitalizations has fallen faster for patients ages 65 and above than for younger adults, according to a new report from the Agency for Healthcare Quality and Research.

According to the report, hospital stay rates fell for angina (without procedure), congestive heart failure and diabetes during 2007. (Diabetes-related hospitalizations among younger adults actually climbed during the same period, the agency said.)

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Advancing Excellence in America's Nursing Homes

Advancing Excellence in America’s Nursing Homes is a national campaign to encourage, assist and empower nursing homes to improve the quality of care and life for residents.

Comprised of long term care providers, medical professionals, consumers, employees, and state and federal agencies, AE is the largest and first coalition of its kind to measure quality by setting clinical and organizational goals for nursing homes.

The coalition stimulates quality improvements by providing nursing homes with free, current and practical evidence-based resources, empowering residents and their families with education, and helping participants reach their targets. Homes can compare their progress with state and national averages.
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The Health Care Blog: State of Health Care Quality: Some States Better Than Others

By Margaret E. O'Keane, President National Committee For Quality Assurance

Suppose you’re one of the 22 million Americans living with diabetes and you have to decide where you want to live. Your choices: Providence, Rhode Island, or Houston, Texas. Providence is pretty and you’d have easy access to lobster dinners and weekends at the Cape. But Houston is warmer in the winter and just a hop, skip and a jump from a weekend in Cancun. A hard decision but you’re leaning toward Houston because, let’s face it, you hate shoveling snow!

But then you take a look at the 13th annual State of Health Care Quality Report by the National Committee for Quality Assurance (plug alert: I run the place) and you find out the quality of care for diabetics is nearly 11 percentage points better in New England than it is in the South Central region of the U.S. and you begin to reconsider. In fact, you look at the newest data released October 22 and you find that the quality of care in the Texas region of the country is consistently the worst while care in New England is almost always the best. Providence here I come!

Here’s the problem: Most people don’t have a choice of moving from Texas or Oklahoma or Alabama to Massachusetts, Connecticut or Rhode Island. They have to live with the health care system they have. For a diabetic, those 11 points can translate into more kidney problems, loss of vision, toe or foot amputations or, heaven forbid, a shorter lifespan.

The thing is, it doesn’t have to be this way. True, care isn’t going to be identical in all parts of the country. And, true, the population of Dallas may have a lot more health problems than the people in Hartford. But 11 points is too big a gap to explain away with demographics.

Regional variations in quality are just one part of this year’s State of Health Care Quality. After 12 years of steady and often remarkable improvements in care by our nation’s health plans, 2008 was marked by a stalling of progress. Care quality in commercial health plans as well as those serving Medicare and Medicaid beneficiaries barely improved.
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Health Affairs Blog: Flat Lining Quality & Implications for Health Reform

by Margaret O'Kane

As Congress prepares for an historic floor debate over health care reform, those of us who have worked in the trenches to measure and improve the quality of care are watching with a mix of anticipation and concern. Reform has the potential to significantly improve the transparency and, ultimately, the quality of our system of care. But I worry that the provisions needed to achieve a transparent, high quality system could end up on the cutting room floor as lawmakers strive to finish the picture.

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Easing Tensions in the Nursing Home - The New Old Age Blog - NYTimes.com

By Paula Span

Margaret Cunningham remembers a fraught encounter at the nursing home where her father, then 89, lived outside Dallas. A number of things bothered her about her father’s care, and she said she felt unable to elicit much cooperation from the staff. So she raised these issues with a social worker.

“She was cold and snippy, just not sympathetic,” Ms Cunningham recalled. “She said, ‘Well, that’s the way it has to be.’ ”
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H.R. 3843: To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to publish... (GovTrack.us)

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To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to publish redacted medical quality-assurance records of the Department of Veterans Affairs on the Internet website of the Department.

Sponsor: Rep. Joe Sestak [D-PA7]

Text

Introduced Oct 15, 2009
Referred to Committee on Veterans Affairs

Updates


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Aiming Higher for Health System Performance: A Profile of Seven States That Perform Well on The Commonwealth Fund's 2009 State Scorecard - The Commonwealth Fund

As a companion to the 2009 State Scorecard, this report profiles seven health systems: six that rank among the top quartile of states—Vermont, Hawaii, Iowa, Minnesota, Massachusetts, and Wisconsin—plus Delaware, which was among the most-improved states from 2007 to 2009. These states demonstrate that high levels of health system performance are achievable and sustainable, and provide useful examples of state policies and practices that may be reasonably associated with health system improvement: a long-term commitment to reform, collaboration among stakeholders, leadership to expand health insurance coverage, transparency of health information, and a capacity to act on emerging best practices. The State Scorecard and this report also show that all states can aim higher in health system performance: if all states improved performance to the levels achieved by the best states, then thousands of lives could be saved and significant cost savings and improved health outcomes could be achieved.
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The Nursing Home as Battle Zone - The New Old Age Blog - NYTimes.com

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Are conflicts with nursing home staff inevitable?
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Aiming Higher: Results from a State Scorecard on Health System Performance, 2009 - The Commonwealth Fund

Focused on identifying opportunities to improve, The Commonwealth Fund's State Scorecard on Health System Performance assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs, and health outcomes. The 2009 State Scorecard paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs. On a positive note, there were gains in children's coverage as a result of national reforms, and improvement in some measures of hospital and nursing home care following federal efforts to publicly report quality data. The scorecard highlights persistent wide variation in performance across states and continued evidence of poor care coordination. Increasing cost pressures and deterioration in access across the U.S., together with geographic disparities in performance, underscore the urgent need for comprehensive national reforms to ensure access, change the trajectory of costs, and enhance value.

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Safety Gurus: Penalize Doctors Who Don’t Follow the Rules - Health Blog - WSJ

By Laura Landro

Should hospitals start penalizing doctors and nurses who fail to follow patient safety rules?

That’s one solution proposed by Peter Pronovost of Johns Hopkins and Robert Wachter of the University of California at San Francisco. Writing in the New England Journal of Medicine, the doctors contend that the failure to hold clinicians accountable for patient safety is the main reason health care is still riddled with errors, adverse events, and just plain non-adherence to some of the most basic rules.
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H.R. 3664: Healthcare Innovation Zone Pilot Act of 2009 (GovTrack.us)

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The Secretary of Health and Human Services shall establish a Healthcare Innovation Zone pilot program to increase health care provider integration and align health care provider incentives to reduce the rate of growth of health care costs while improving quality of care for Medicare, Medicaid, and privately insured patients. The HIZ program, by including teaching hospitals, shall provide for the incorporation of new and innovative clinical initiatives for the training of the next generation of physicians, nurses, and other health professionals in a new model of cost-effective, high-quality health care.

Sponsor: Rep. Allyson Schwartz [D-PA13]

Full Text

Status:

Introduced Sep 29, 2009
Referred to Ways and Means Committee

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