This March the federal government received an unusual suggestion from the National Quality Forum’s (NQF) Measure Applications Partnership (MAP). In MAP’s 2017 guidance to the Department of Health and Human Services (HHS),the organization recommended eliminating around 51 out of 240 of all federal quality metrics used to determine payment in seven federal healthcare programs. This is meant to make the requirements for providers more efficient and streamlined.
MAP’s job is to review the quality measures put out by NQF each year. however, it’s CMS’s job to decide which of those measures to use.
“We want to make sure we can take away measures that are adding burden but not value,” said Helen Burstin, MD, MPH, FACP, NQF’s chief scientific officer, in a call with reporters. “This is really just the start.”
Many in the healthcare field state that the 634 quality measures applicable to federal healthcare programs is putting an undue burden on providers. However, as the industry is switching between payments based on quality rather than volume, the need for quality metrics is apparent. MAP aims to work towards both ends by culling measures that are redundant or pointless.
The measures that MAP recommends eliminating come from several programs, such as the Prospective Payment System—Exempt Cancer Hospital Quality Reporting Program, the Ambulatory Surgery Center Quality Reporting Program, the Inpatient Psychiatric Facility Quality Reporting Program, and the Home Health Quality Reporting Program. It also recommends eliminating:
• Four out of 18 measures used in the End-Stage Renal Disease Quality Incentive Program
• 13 out of 29 used in the Outpatient Quality Reporting Program
• Six out of 62 used in the Inpatient Quality Reporting Program
On February 10, the U.S. Senate voted 52 to 47 confirming Rep. Tom Price, MD (R-GA) as the new head of the Department of Health and Human Services (HHS). Price is an orthopedic surgeon and the first physician to head the HHS since the George H.W. Bush administration. He’s known for his opposition to the Affordable Care Act.
Price’s appointment has been highly controversial, in part due to his investments in healthcare companies that could potentially benefit or be harmed by his actions as HHS secretary.
A recent survey of nearly 1,100 physicians revealed a sharp divide in opinions on Price’s appointment; with 46% feeling positive and 42% leaned negative. The survey also revealed that 47% of respondents believe that Price will diminish patients’ ability to access quality care, with 42% who believed the opposite.
Efforts to improve patient safety are paying off, according to a new Health and Human Services (HHS) department report. Between 2010 and 2015, increased patient safety efforts have:
• prevented 3.1 million hospital-acquired conditions (HAC), a 21% decline
• saved 125,000 lives
• saved $28 billion in healthcare costs
In the announcement, HHS Secretary Sylvia Burwell cited the Affordable Care Act as a major cause of the improvement in patient safety.
“The Affordable Care Act gave us tools to build a better healthcare system that protects patients, improves quality, and makes the most of our healthcare dollars and those tools are generating results,” said HHS Secretary Sylvia M. Burwell. “Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital-acquired conditions, resulting in thousands of lives saved and billions of dollars saved.”
There are other federal patient safety efforts mentioned in the report as aiding in patient safety improvement. Among those cited were the Partnership for Patients initiative, a public-private partnership launched in 2011 though CMS Innovation to target a specific HACs. CMS also worked with hospital networks and aligned payment incentives to improve focus on making care safer.
“These achievements demonstrate the commitment across many public and [more]
This October, the Department for Health and Human Services (HHS) announced ambitious, new targets for reducing healthcare-associated infections (HAI) in acute care hospitals, long-term care facilities, and ambulatory surgical centers. The changes have been outlined in the National Action Plan to Prevent HAI: Road Map to Elimination. The HHS used HAI data from 2015 as a baseline, with the new target date set for 2020.
The previous targets for HAI reduction expired in 2013, with only the goal of reducing central line-associated bloodstream infections (CLABSI) by 50% achieved. All others saw partial success, save catheter-associated urinary tract infections (CAUTI) and Clostridium difficile (C. diff) hospitalizations. Between 2009 and 2014, there was no change in CAUTI reduction. Meanwhile, C. diff hospitalizations actually increased by 18%.
Now, the HHS’s new goals require:
- 50% CLABSI reduction
- 50% CAUTI reduction
- 25% invasive Methicillin-resistant Staphylococcus aureus (MRSA) reduction
- 50% facility-onset MRSA reduction
- 50% diff Infection (CDI) reduction
- 30% surgical site infection (SSI) reduction
- 30% reduction of diff hospitalizations
Facilities should have already started working on reducing CAUTIs, since The Joint Commission’s newest National Patient Safety Goal (NPSG) on CAUTIs will go into effect on January 1, 2017.
The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.
“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”
The GAO says there are three main drivers of these misalignments:
- Dispersed decision-making:Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
- Variation in data collection and reporting systems:The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
- Few meaningful measures:Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.
“What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one,” said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.
The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.
For those anxiously awaiting President Obama’s second nomination for Secretary of Health and Human Services (HHS), the wait is over. The governor of Kansas, Kathleen Sebelius, democrat, is the president’s next choice for the position. Sebelius, who I mentioned in this posting on the Patient Safety Monitor blog as a possible candidate as secretary of HHS, has a track record of working closely with health insurers in her home state. In fact, prior to working as the governor, Sebelius served as Kansas’ state insurance commissioner. Her nomination has received praise from both republicans and democrats alike. Unlike Obama’s first nomination for HHS secretary, Tom Daschle, Sebelius will not serve as both HHS secretary and “healthcare czar,” a position that will specifically focus on reforming healthcare.
Should Sebelius be confirmed, she will have a lot on her plate as soon as she starts. A commissioner of the Food and Drug Administration has yet to be named, mostly because of the delay in confirming an HHS secretary. Known for her pro-abortion and stance and bipartisan policies, Sebelius successfully blocked the sale of Blue Cross Blue Shield of Kansas to Anthem Inc. because she said it would have raised insurance premiums for residents of the state.
Do you have any initial thoughts about President Obama’s choice?