National Quality Forum

Federal bill would link Medicare hospital pay to quality

Anne Zieger — Fri, 21 Nov 2008 09:14:55 -0500

Now here's a bill that would scare me a bit if I were a hospital administrator--even if it was inevitable (and it is) that such a measure would be written. Sens. Max Baucus (D-MT) and Chuck Grassley (R-IA) have drafted legislation that would link Medicare reimbursement for inpatient hospital care to the quality of that care rather than the number of services provided.

Yes, this is the way things have been going for some time, between the drive to bundle care--as Geisinger has done with some procedures--and quality incentives, but this definitely takes things a step further in the direction of so-called "value-based purchasing." (Value-based purchasing: now there's a concept that's a million times easier to talk about than to actually realize.)

The bill would kick off the new policy in fiscal 2012 and be phased in over four years through FY 2016. Medicare reimbursement levels would be based on quality standards from a list of measures from several groups, including the National Quality Forum.

To learn more about this bill:
- read this Kaiser Daily Health Policy Report article

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AHA asks CMS to reconsider 2009 quality measures, payment rates

Anne Zieger — Fri, 29 Aug 2008 09:49:06 -0400

The American Hospital Association isn't too happy about the quality-reporting requirements in the new proposed outpatient prospective system rule for 2009, and it would like to see CMS make some changes. For one thing, it doesn't like the medical-imaging efficiency measures, which haven't gone through the National Quality Forum endorsement process, or been adopted by the Hospital Quality Alliance. The AHA argues that the measures should be vetted by both groups.

Meanwhile, the AHA says CMS hasn't demonstrated that creating two cost centers for drugs--which will impose new accounting and billing burdens on hospitals--will actually improve payment accuracy. Also, the group argues that the proposed payment rate for separately covered outpatient drugs is based on a method that contains flaws. The proposed payment rate, at an average sales price plus 4 percent, doesn't represent the acquisition cost of outpatient drugs. AHA is recommending a rate of the average sales price plus 6 percent, as paid to physician offices.

On the other hand, the AHA supports the CMS process for validating outpatient quality data, which AHA says will improve the accuracy of quality data, and already improves on the inpatient program, as well as its proposal to pay for partial hospitalization programs using two new ambulatory payment classes. AHA would like to see hospital-based partial hospitalization rates paid for both ambulatory payment classes.

To learn more about the letter:
- read this Modern Healthcare article
- read the AHA letter (.pdf)

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Trend: Hospitals apologize for mistakes publicly

Anne Zieger — Fri, 08 Aug 2008 13:35:47 -0400

Typically, hospitals have shied away from the legal exposure and bad publicity that come with apologizing publicly for mistakes. Lately, however--prompted by the industry's increasing push toward transparency--a number of hospitals have gone public with mistakes made by their teams. This includes a recent episode at Park Nicollet Methodist Hospital in which the wrong, non-cancerous kidney was removed from a patient due to incorrect documentation in the patient's chart. Park Nicollet and at least five other health care organizations faced with undeniable errors that caused serious harm have let the world know that they're sorry.

Right now, five states require some type of adverse-event disclosure to patients, and even require reporting of 28 "never events" identified by the National Quality Forum. Now, as laws protecting expressions of empathy, regret and apologies from admissibility in court become more common, hospitals are growing bolder. While some critics fear that the apologies will generate too much legal exposure for doctors, others hail the disclosures as a big step forward for patients.

In theory, such disclosures are a smart public relations strategy, as experts on public disclosure of bad news generally suggest the institution disclose the news on its own. But hospital administrators say that they're doing this because it's the right thing to do, because it enhances trust, and because it helps professionals learn from each other.

To learn more about this trend:
- read this AMNews article

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IL Blue plan won't pay for errors

Anne Zieger — Fri, 08 Aug 2008 11:22:18 -0400

Blue Cross and Blue Shield of Illinois has become the latest Blue plan to roll out a policy banning payment for medical errors by hospitals. It's become one of several fellow Blue plans to announce such a policy in the wake of an announcement by the Blue Cross and Blue Shield Association last November that its affiliates would be introducing such rules. Plans in states including Texas, Massachusetts, Michigan and Rhode Island have already announced their participation in the initiative.

According to the health plan, it will work with hospitals to roll out the policy, but it hasn't yet defined which conditions and events will be addressed. More typically, health plans that make such an announcement have been modeling their policies after CMS's list of conditions and never events for which it won't reimburse. Never events, typically those named by the National Quality Forum, usually include wrong-side surgery or discharge of an infant to the wrong family.

This is part of a larger national movement emerging to support non-payment for never events and preventable conditions. For example, earlier this summer the trade group for California health insurers, the California Association of Health Plans, announced that it had passed a resolution in favor of no longer paying for CMS's list of never events, as well as three preventable mistakes.

To learn more about this trend:
- read this Modern Healthcare article (reg. req.)

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MA Blue plan, state ban payment for medical errors

Anne Zieger — Thu, 19 Jun 2008 13:09:02 -0400

In another major blow for this approach, the state of Massachusetts' Medicaid program and the largest health insurer there each announced that they won't pay for a list of "never events." This week, Blue Cross and Blue Shield of Massachusetts and the state's MassHealth both said that they won't pay for 28 types of surgical, medication and other errors compiled by the National Quality Forum. Collectively, the two insurers cover about 4 million people in the state, making their decision influential not only in the state, but nationally as well. This follows a round of voluntary commitments by hospital administrators in Massachusetts who have begun vowing not to charge any insurer for medical errors, and instead promise to absorb the costs on their own.

While it's not clear how this policy will affect the Medicaid program, the state, whose public health department recently began requiring that hospitals and doctors report such mistakes, had previously found that 70 such errors were reported during the five five months of the year. More in question is how MassHealth will implement and enforce its policy. Processing 6 million claims a month, it's not clear yet how MassHealth will scan claims to make sure that it's not paying for treatment related to medical mistakes.

To learn more about the insurers' decision:
- read this article from The Boston Globe

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AHA says CMS hospital quality measures aren't ready

Wed, 11 Jun 2008 06:59:57 -0400

As things stand, hospitals soon will have to report on 72 quality measures (up from 30) if they want to receive full Medicare reimbursement. However, most of the new quality measures proposed by CMS for its fiscal 2009 budget aren't ready to be reported on yet, according to the American Hospital Association.

Of the 43 new measures CMS has proposed, only 10 have been adopted by the Hospital Quality Alliance, and what's more, many have not been endorsed by the National Quality Forum, wrote the AHA in a letter to the agency. AHA doesn't believe that the 33 measures not yet adopted by the Hospital Quality Alliance are ready for reporting. What's more, adding that many more measures may actually confuse hospitals as to what their priorities should be, according to AHA Executive Vice President Rick Pollack.

To learn more about the AHA's concerns:
- read this Modern Healthcare article (reg. req.)
- read the AHA's comments (.pdf)

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Joint Commission releases new inpatient psych measures

Tue, 10 Jun 2008 06:59:56 -0400

The Joint Commission has released a new set of seven inpatient psychiatric measures for use with the group's Oryx performance-measurement requirements. Eventually, the data will appear on the Commission's Quality Check website, which offers quality data comparisons for hospitals. The measures, which go into effect Oct. 1, are admission screening for violence risk, substance use, psychological-trauma history and patient strengths assessment; hours of physical restraint use, hours of seclusions use, patients discharged on multiple antipsychotic drugs, patients on multiple anti-psychotics with appropriate justification, post-discharge plan created and post-discharge continuing-care plan transmitted to next level of care provider on discharge. Now, the Joint Commission is asking for an endorsement of the measures from the National Quality Forum.

To learn more about the standards:
- read this Modern Healthcare piece (reg. req.)

ALSO NOTED: NQF releases healthcare-acquired infection reporting guidelines; ACOG re-examines abortion referral opinion; and mu

Tue, 08 Apr 2008 06:59:50 -0400

> The National Quality Forum has released a new framework for reporting data on healthcare-associated infections, and has released seven new performance measures. Article

> Faced with controversy over its abortion referral guidelines, which some anti-abortion doctors fear could jeopardize their board certification, the American College of Obstetricians and Gynecologists may re-examine its stand. Article

> Vanderbilt University will soon be offering a new doctor of nursing practice degree. Article

> Duke University Medical Center has received a $50 million gift, the biggest in its history, part of which it will use to build a new inpatient facility for its Children's Health Center. Article

And Finally... Chasing away angry dogs may be par for the course...but turkey attacks are a bit much. Articles

Groups come together on MD performance reporting

Wed, 02 Apr 2008 07:59:58 -0400

Measuring performance is one of the toughest nuts the healthcare industry has to crack. But this time, some important stakeholders have at least come together to handle the problem as a team. Groups backing the new Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs include the American Medical Association, American Academy of Family Physicians, the AARP, American College of Physicians, America's Health Insurance Plans, the Leapfrog Group, AFL-CIO, National Business Coalition on Health and health insurers Aetna, Cigna, UnitedHealth Group and WellPoint.

The Charter creates a set of shared principles that will structure measuring and reporting on doctor performance. It urges health plans to develop consistent performance measurements on cost and quality, adopt National Quality Forum standards; use transparent methods for creating programs and give physicians a chance to participate and, if they desire, appeal their scores.

To learn more about the project:
- read this Modern Healthcare piece (reg. req.)
- visit the group's website

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NQF develops coordination of care measures

Wed, 02 Apr 2008 07:59:54 -0400

The National Quality Forum plans to begin developing quality measures related to coordination of care over the next 15 months, a move that could help to boost the emerging trend toward giving patients medical homes. NQF already measures some aspects of care coordination, but the new standard will expand its focus. Now, it's beginning research on relationships among doctors of various specialties, provider roles and family understanding of treatment plans. It will use this data to develop standards for medication management, transitions and handoffs. Execs there hope the standards will help medical teams work together more effectively.

To learn more about the standards:
- read this Modern Healthcare piece (reg. req.)

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