What does the National Healthcare Agenda Mean to Us?

1. What does the National Healthcare Agenda Mean to Us? Developed in cooperation with Patricia C. Kienle, MPA, FASHP and Wayne S. Bohenek, Pharm.D., M.S., FASHP Reviewed July 2009

2. What do we mean by “Quality”? Safe - avoiding injuries to patients from the care that is intended to help them Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively) Patient Centered - providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions Timely - reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient - avoiding waste, including waste of equipment, supplies, ideas, and energy Equitable - providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

3. Stakeholder Response to Patient Safety Regulatory Mandatory requirements for accreditation IHI AHRQ ISMP ASHP NQF High Quality Safe Care Government Monitor provider organizations through mandatory and voluntary reporting. Institution Initiatives Specific initiatives identified by this institution. Financial Issues Do more with less Payers Provide incentives to providers that use tools to increase safety and can demonstrate performance. Employers Leapfrog

4. Key Organizations • The Joint Commission • Medicare (CMS) • Agency for Healthcare Research and Quality (AHRQ) • Institute of Medicine (IOM) • Institute for Healthcare Improvement (IHI) • ASHP 2015 • National Quality Forum (NQF) • The Leapfrog Group • Quality Alliances

5. The Joint Commissionwww.jointcommission.org

6. National Quality Forum www.qualityforum.org 2007 2003 2003 2003 2005

9. www.hospitalcompare.hhs.gov and www.medicare.gov • Hospital Quality Alliance (HQA) http://www.qualitynet.org

10. Quality Drivers • External drivers • Core Measures • Surgical Care Improvement Project • IHI 5 Million Lives campaign • Public reporting • Medicare stop payment for errors • Internal drivers • Pay for Performance (P4P) initiatives

11. Quality Indicators National Goals Measure Development NQF Endorsement Measure Selection Data Collection, Aggregation, Verification Public Reporting and Accountability Quality Improvement Were the goals achieved?

12. Annual Payment Update Hospital Quality Alliance Joint Commission CMS Growth of Publicly Reported Measures 2004 – Annual Payment Update of .4% tied to submitting 10 HQA measures 2007 – Annual Payment Update of 2% tied to submitting 21 HQA Measures and CMS able to add additional measures; HCAHPS next. 50 45 40 35 30 Number of Measures 25 20 15 10 5 0 Jul 06 Apr 05 Oct 06 Oct 07 Mar 07 Sep 05 Nov 04

13. Performance (Core) Measures • Acute Myocardial Infarction (AMI) • Heart Failure (HF) • Pneumonia (PN) • Pregnancy and related conditions (PRC) • Surgical Infection Prevention(SCIP)

14. Acute Myocardial Infarction • Thrombolytics • Time to administration • Drugs at discharge • Aspirin • ACE inhibitor or ARB for left ventricular systolic dysfunction • Beta blocker • Adult smoking cessation counseling

15. Surgical Care Improvement Project • Project Goal: decrease incidence of surgical complications by 25% by 2010 • SCIP • Cardiac • Infections • Respiratory • Venous Thromboembolism • End-Stage Renal Disease

16. SCIP • Cardiac • Beta blockers • Infections • Surgical site infections • Respiratory • Post-operative pneumonia • Venous thromboembolism • Prophylaxis

17. Pay for Performance (P4P) • “Groundbreaking . . . Pay for performance should become a top national priority” • Open letter in Health Affairs signed by 15 leaders in the quality movement. • “I would like to see 5,000 hospitals participating.” • Tom Scully in Modern Healthcare • “Fix For a Sick System” • InformationWeek Source: Premier, Inc

18. Condition X Condition X Condition X 1st Decile 2nd Decile 1st Decile 3rd Decile Hospital 4th Decile 1st Decile 2nd Decile Top Performance Threshold 5th Decile 3rd Decile 6th Decile 2nd Decile 4th Decile 7th Decile 5th Decile 8th Decile 3rd Decile 9th Decile 6th Decile 4th Decile 10th Decile 7th Decile Hospital 5th Decile 8th Decile 9th Decile 6th Decile 10th Decile 7th Decile Payment Adjustment Threshold Hospital 8th Decile 9th Decile 10th Decile Year Three Year One Year Two Anticipated Payment Scenario Source: Premier, Inc

19. Centers for Medicare and Medicaid (CMS) Outpatient Quality Reporting Measures for 2009 • Hospitals will be asked to report the following measures, mostly for ED and Ambulatory Surgery patients: • OP-1 ACEI or ARB for LVSD prescribed for patients with heart failure • OP-2 HgA1c poor control in Type 1 or 2 diabetes mellitus measured during • the last 12 months • OP-3 Empiric antibiotic selection for community-acquired pneumonia • (CAP) in immunocompetent patients • OP-4 Prophylactic antibiotic initiated within one hour prior to surgical • incision • OP-5 Prophylactic antibiotic selection for surgical patients • OP-6 Aspirin at arrival • OP-7 Median time to fibrinolysis • OP-8 Fibrinolytic therapy received within 30 minutes of ED arrival • OP-9 Median time to ECG • OP-10 Median time to transfer to another facility for acute coronary • intervention

20. ASHP Website and 2015 Crosswalk www.ashp.org/qii

21. What’s Next? • Tight glycemic control • Asthma care • Stroke management • Diabetes • ?

22. What are we doing?

23. Summary Understand the National Healthcare Agenda Understand How this Institution Prioritizes the National Agenda Develop and Align Our Pharmacy’s Programs Accordingly Influence you Facility’s Strategic Direction Develop Skills in Performance Improvement And Change Management