Tag: quality
Administrative Simplification: Adoption of Operating Rules for Health Plan Eligibility and Health Care Claim Status Transactions
Posted by Mark Dorley on April 13, 2012
On July 8, 2011 the Secretary of the Department of Health and Human Services (HHS) issued an Interim Final Rule with Comment Period (IFR) regarding the operating rules for two types of HIPAA transactions: eligibility for a health plan and health care claim status. The rules are in response to Section 1104 of the Affordable Care Act (ACA), which directed the Secretary to adopt certain operating rules for transactions to enable electronic health information exchange and create greater uniformity in the transmission of health information.
The ACA defines operating rules as…
Health Affairs article finds Medicare’s pay-for-performance program did not spur quality improvement
Posted by mmcdowell on April 11, 2012
Medicare’s flagship hospital pay-for-performance program, the Premier Hospital Quality Incentive Demonstration, began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, the authors of a recent Health Affairs article found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, the authors found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. The findings in this article raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.
Commonwealth Fund releases report with guidelines regarding quality improvement reporting
Posted by mmcdowell on
A provision of the Affordable Care Act (ACA) requires health plans to submit reports each year demonstrating how they reward health care quality through market-based incentives in benefit design and provider reimbursement structures. By spring 2012, the U.S. Secretary of Health and Human Services (HHS) is expected to develop requirements for health plans to report on their efforts to: improve health outcomes, prevent hospital readmissions, ensure patient safety and reduce medical errors, and implement wellness and health promotion activities. Both employer group health plans, including self-insured plans, individual market plans, and qualified health plans sold through the insurance exchanges are required to submit such reports.
A report recently published by The Commonwealth Fund outlines key considerations…
RWJF and Urban Institute paper addresses patient-centered care in the ACA
Posted by mmcdowell on March 12, 2012
The Robert Wood Johnson Foundation (RWJF) and Urban Institute recently released a paper examining the increased emphasis on a patient-centered care system under the Affordable Care Act (ACA). According to the Institute of Medicine (IOM), patient-centeredness means “care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” Through provisions requiring quality of care measurements, public reporting, and performance payments, the ACA reflects the movement toward patient-centered care. Although the ACA provisions are a significant milestone in the development of patient-centered health care delivery, rhetoric will need to be matched with funding for data collection, building consensus on measure use, and the integration, alignment, and harmonization of measures in different programs.
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Update: Release of Medicare Data for Performance Measurement
Posted by mmcdowell on February 24, 2012
Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA) [1], which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making. Across the country, community organizations, such as the Alliances participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, have been demonstrating the power of using private payer and Medicaid medical claims data to measure and publicly report on provider performance. Their work could be further strengthened by access to Medicare claims data because it is the single largest pool of information about how health care is delivered in America. Combining Medicare data with data from other public and private payers such as Medicaid and employer sponsored plans, holds the potential to generate more complete and accurate provider performance measurement information, thereby further empowering consumer engagement and quality improvement.
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The Center for Medicare and Medicaid Innovation: A Year’s Progress
Posted by Mark Dorley on January 26, 2012
Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.
To foster the development of more collaborative and…
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HHS releases Medicaid quality measures
Posted by mmcdowell on January 6, 2012
The Department of Health and Human Services (HHS) December 31, 2011 released a set of 26 quality measures to help track and improve health care delivered to Medicaid enrollees. The 26 quality measures are grouped into six major categories: 1) prevention and health promotion (e.g., flu shots for adults); 2) management of acute conditions (e.g., follow-up after hospitalization); 3) management of chronic conditions (e.g., controlling high blood pressure); 4) family experiences of care (e.g., surveys); 5) care coordination (e.g., timely transmission of records among providers); and 6) availability of care (e.g., prenatal and postpartum care). The development of these quality measures is mandated under the Affordable Care Act (ACA). Initially, HHS released a set of 51 proposed measures on December 31, 2010 and accepted public comments for two months. HHS reportedly received about 100 comments, many of which pertained to the overwhelming volume of quality measures. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), and other agencies within HHS were involved in pairing down the final core set to 26 quality measures.
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Hospital Readmissions Reduction Program
Posted by Mark Dorley on November 1, 2011
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
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CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project
Posted by mmcdowell on October 24, 2011
The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.
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Commonwealth Fund publishes National Scorecard on U.S. Health System Performance, 2011
Posted by mmcdowell on October 18, 2011
The Commonwealth Fund debuted the “National Scorecard on U.S. Health System Performance, 2011″ in a press briefing at the Kaiser Family Foundation on October 18, 2011. Cathy Schoen, the Senior Vice President for Research and Evaluation at Commonwealth, summarized the report, which updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. The report notes substantial improvement on several care quality indicators. However, the U.S. fell short on key measures as well. Across 42 performance indicators, the U.S. achieved a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Costs rose sharply, access to care declined, health system efficiency remained low, health disparities persisted, and heath outcomes also fell below target. The Affordable Care Act (ACA) targets many of the important gaps identified by the Commonwealth Scorecard.
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