New RWJF Resource on Hospital Quality Data

The Robert Wood Johnson Foundation has created a national directory designed to enable the public to access reliable hospital quality data through a centralized database. Consumers can search by state and browse reports. The purpose of creating the tool is to allow the public to have easy access to reliable information on quality of care in their communities. The database currently houses 182 state and local public reports and 26 national reports.

Nominations for AHRQ Quality Indicators Workgroup

The Agency for Healthcare Research and Quality (AHRQ) is seeking nominations for both a time-limited workgroup and a standing workgroup to be convened by an AHRQ contractor. The workgroups shall be comprised of individuals with knowledge of the AHRQ Quality IndicatorsTM (QIs), their technical specifications, and associated methodological issues. The overarching goals of each group are to provide feedback to AHRQ regarding refinements to the QIs. The time-limited workgroup is more restricted to specific clinical or methodological issues, while the standing workgroup addresses broader issues related to the measurement cycle.

Because AHRQ did not get a set of candidates with anticipated breadth of diversity of experience as required in response to our notice published on January 28, 2013, AHRQ resubmits the same notice to give opportunity to those interested in this objective.

DATES: Please submit nominations on or before May 3, 2013. Self-nominations are welcome. Third-party nominations must indicate that the individual has been contacted and is willing to serve on the workgroup. Selected candidates will be contacted by AHRQ no later than May 17, 2013. Please include the workgroup of interest. Candidates may apply for both workgroups.

Hospital Begins Publishing Detailed Patient Safety Information

According to the Boston Globe, Brigham and Women's Hospital has begun an ambitious effort to openly recount patient safety mistakes, and the improvements they led to, in a monthly online newsletter for its 16,000 employees. Brigham leaders started the publication to encourage staff to talk openly about their mistakes and propose solutions, and help make sure errors are not repeated.

While many hospitals post information on their websites about patient infections and falls, they rarely provide details of medical errors or candidly discuss with their entire staff how medical mistakes harmed patients. Executives fear the public will find out, sparking lawsuits and scaring off patients. This reluctance, patient safety advocates warn, may be hampering the push to reduce medical errors because there is not wide discussion of how mistakes happen and can be prevented.

The Brigham doesn’t make the newsletters readily available to the public — but it doesn’t hide them either; it gave the Globe all issues. The Brigham began publishing “Safety Matters” online in January 2011 on its employee intranet and will start distributing paper copies in staff lounges, conference rooms, and other gathering spots later this spring — a move that some hospital administrators initially opposed because they worried about scaring patients. Most issues tell a story of medical care gone awry through interviews with caregivers and often with patients, and describe the hospital’s response. Patients are not named, to protect their privacy. Caregivers also are anonymous because hospital leaders do not want to discourage them from reporting problems.

NCQA Launches Specialty Practice Recognition Program

The National Committee for Quality Assurance—architect of America’s most popular patient-centered medical home model—has extended medical home concepts to specialists and released its latest program: NCQA Patient-Centered Specialty Practice (PCSP) Recognition.

Now specialty practices committed to access, communication and care coordination can earn accolades as the “neighbors” that surround and inform the medical homes and colleagues in primary care.

Practices that become recognized will demonstrate patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement.

Earning NCQA Patient-Centered Specialty Practice Recognition shows consumers, private payers and government agencies that a specialty practice has undergone a rigorous review of its capabilities and is committed to sharing information and coordinating care. Recognition also signals to primary care practices that a specialty practice is ready to be an effective partner in caring for your shared patients.

Health Insurers Spent Less Than 1% of Premium Dollars on Care Improvement in 2011

Health insurance companies reported spending an average of less than 1 percent of the premiums they collected from policyholders in 2011 on activities directly supporting improvement of health care quality, according to a Commonwealth Fund study released today.

The new report, by Mark A. Hall and Michael J. McCue, looks at differences in medical loss ratios, consumer rebates, and quality improvement expenses, based on insurers' corporate structure and ownership. The authors find that insurance companies spent a combined $2.3 billion on direct quality improvement activities―an average of $29 per subscriber. The study examines all segments of an insurer's book of business, from individual market policies to large group self-insured.

The Affordable Care Act's medical loss ratio rule requires insurers to spend at least 80 or 85 percent of premiums on medical claims and quality improvement activities―those likely to improve health outcomes, prevent hospital readmissions, improve patient safety, and increase wellness and health promotion―or else pay rebates to consumers.

CMS Announces Hospital Readmission Rate Penalties

More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.

Opportunity to Participate in a Discussion on California Health Insurance Exchange Design

On Wednesday, August 1, the California Health Benefits Exchange will hold a stakeholder webinar to discuss quality and affordability of Qualified Health Plans offered in its exchange. NBCH staff has been working with the California exchange to incorporate eValue8, where appropriate, and this webinar will include a discussion of the use of eValue8.    State exchanges are required to develop guidelines for how quality information is collected and reported, and eValue8 is an existing tool that states may consider using for this purpose.  NBCH has been working with other states as well, and supports standardization of quality information, and is willing to work with exchanges to create flexible platforms to store information in a dynamic way for plans to update and consumers to use.  NBCH is also willing to support enhancements and some tailoring of questions in eValue8, such as for the disparities section.  Members who have been involved in the eValue8 process, as well as those who are interested in learning more about either eValue8 or the state health insurance exchanges, are welcome to participate.  

NBCH is in the process of developing a member education strategy around health insurance exchanges, and this California opportunity is one of many ways in which we anticipate being involved in the development of exchanges.  If you would like to provide feedback or input on ways in which NBCH can be helpful as coalitions navigate policy issues related to exchanges, please let Colleen Bruce know.  

Opportunity to Provide Input on NQF’s Measure Registry

Health care stakeholders have expressed interest in being able to consistently identify and track measures and their related versions, including eMeasures, along the measure development, endorsement, and use pipeline. HHS has contracted with the National Quality Forum (NQF) to explore key issues and considerations for a single system or approach to gathering, storing, and accessing measure information.  This project is titled the Measure Registry Needs Assessment. In its role as a neutral convener, NQF will gather perspectives and information from any interested stakeholders across the quality measurement enterprise. The information gathered through this process will be publicly available for review and use by any individual or organization. 

NBCH has been asked to participate in some initial meetings with NQF staff.  We have emphasized that the registry should be created with the end-user in mind – particularly employers and consumers – rather than with the measures developers in mind, which was CMS’s original intent. Our recommendation is that NQF use this as an opportunity to boost use of measures by employers and consumer groups. 

In order to give further voice to that recommendation, all coalitions are invited to participate in a webinar with NQF on Thursday, July 26 at 1:00 (eastern).  This is a great opportunity to ask questions or voice concerns about measure use.  Specifically, coalitions may want to emphasize the following points:

·         The need to link measure information with use and impact.

·         The registry will be most helpful if it has the functionality to generate reports and aggregated results about which measures are currently in use for cost and quality transparency and payment in both the public and private sector

·         Coalitions could also simply express the need to have implementation guidance for measure specifications. 

These and any additional topics or issues for discussion would be welcomed by NQF.  Don’t miss this opportunity to provide a unique and valuable perspective on behalf of your employer members!

Finally, NBCH is exploring ways to support our members in your efforts to use measures in your activities. We request your input on these ideas, and your feedback about whether this would be a valuable resource for you. Please email Colleen with your thoughts, and we will discuss them at the next all member meeting on August 21, 2012. 

Study Finds Consumers Choose High-Value Health Care Providers When Given Good Cost and Quality

When asked to choose a health care provider based only on cost, consumers choose the more expensive option, according to a new study funded by HHS’ Agency for Healthcare Research and Quality (AHRQ) that appeared in the March issue of Health Affairs.

The study found that consumers equate cost with quality and worry that lower cost means lower quality care. But higher costs may indicate unnecessary services or inefficiencies, so cost information alone does not help consumers get the best value for their health care dollar

"An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-Value Health Care," found that when consumers were shown the right mix of cost and quality information, they were better able to choose high-value health care providers—defined as those who deliver high-quality care at a lower cost.

End this medical secrecy

Transparency in health care is one of the key tools consumers have to help them judge the quality of health care. Transparency allows the public to see where mistakes have been made. Unfortunately, that transparency has been steadily disappearing under the misnamed "Patient Safety and Quality Improvement Act," which not only allows data about medical mistakes to be hidden, it makes disclosing quality problems at providers a crime for anyone except the providers involved. Read the full article...

Crosswalk of the First Set of Priorities for the Pediatric Healthcare Quality Measures Program Centers of Excellence with the CHIPRA Initial Core Measure Set

This chart cross-references CHIPRA topics and measures from the initial core set of children's health care quality measures with the first set of priorities identified for the Pediatric Quality Measures Program and the lead Center of Excellence and principal investigator that will be addressing each topic/measure. See the chart here...

Employee incentives drive lower-cost health care

Employers say they hope the efforts, often called "reference pricing," will get patients to act more like consumers — and drive down the cost of some procedures.

"This sends a signal to (medical) providers about what is considered a reasonable and acceptable price," says David Lansky, who is closely watching the California efforts by Safeway and Calpers from his post as CEO of the Pacific Business Group on Health, a San Francisco-based coalition of employers. Read the full article...

FINDING HELP ON PRICING, QUALITY
Consumers looking for cost or quality information on medical care are often stymied. A few insurers provide specific costs for procedures, while others give ranges. There are also a few national websites. Cost data vary from what is actually paid to estimates based on "charges," or the list price before insurers negotiate discounts. Here are some resources:

COSTS
Fair Health, fairhealthconsumer.org
Estimates out-of-network costs for some medical and dental procedures that can be customized by ZIP code.

Healthcare Blue Book,healthcarebluebook.com
Also customizable by ZIP code, the site estimates payments that providers will accept from insurance companies.

QUALITY MEASURES
Hospital Compare,hospitalcompare.hhs.gov
Medicare's Hospital Compare includes a variety of measures to compare specific hospitals.

The Leapfrog Group, leapfroggroup.org
Assesses hospital performance on some selected quality measures.

New Data Available on WhyNotTheBest.org

WhyNotTheBest.org has been updated with the most recently available data for the following:

• CMS process-of-care "core" measures; 
• Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of patient experience; 
• mortality rates for heart failure, heart attack, and pneumonia; 
• readmission rates for heart failure, heart attack, and pneumonia; and 
• average reimbursement for treatment of these three conditions. 

Users of WhyNotTheBest.org can conduct side-by-side comparisons of more than 5,200 hospitals nationwide, track performance over time against numerous benchmarks, and learn from case studies of top performers. You also can compare performance on the county level by accessing the interactive map.

Value in Health Care: Key Information for Policymakers to Assess Efforts to Improve Quality While Reducing Costs

The U.S. has devoted an increasing proportion of its economy and federal budget to the provision of health care services, but high levels of spending do not guarantee good care. This report (1) examines the availability of evidence on the effect of selected interventions on quality of care and costs; (2) identifies key dimensions for assessing the strength of such evidence; and (3) examines factors that can facilitate the implementation and replication of health care interventions. Download the full report here...