Quality Initiative

1. Quality Initiative Ensuring Success in Washington State

2. For audio, dial:1-800-936-4606 Host is Washington State Hospital Association

3. Welcome!We will begin the presentation at 12:05 to allow all participants time to log in.

4. Quality Initiative Ensuring Success in Washington State

5. Presenters Diana Migchelbrink, RN, MPH Nurse Consultant, Region X Centers for Medicare and Medicaid Services Brenda Suiter,MHA Director, Rural and Public Health Washington State Hospital Association Les Barnette, MD Medical Director, Healthcare Improvement Qualis Health

6. Webcast Outline • AHA Quality Initiative • Medicare Modernization Act (MMA) • Data Collection • Next Steps • Resources

7. Poll Has your hospital already signed up to participate in the Quality Initiative? Yes No Not sure

8. AHA Quality Initiative

9. What Is the Quality Initiative? • Voluntary program for measuring hospital quality • Supported by: • AHA, AMA, Federation of American Hospitals, Association of Medical Colleges • The Centers for Medicare & Medicaid Services (CMS) • JCAHO • Consumer, union, and business groups • Measures quality in three standardized areas: heart attack, heart failure, pneumonia • Displays data on the web

10. Goals of the Quality Initiative • Create a common data set of quality information • Demonstrate commitment to the best patient care • Share information about recognized quality indicators • Empower consumers to make informed decisions • Stimulate quality improvement

11. Benefits of the Quality Initiative • Eliminate duplication and confusion among different quality programs • Create quality reports not designed to make money • Engage hospitals in choosing basic measures that reflect hospital quality • Receive higher Medicare payments

12. WSHA Board Resolution May 2003 • Encourages hospitals to participate • Affirms intention not to use any information generated for competitive marketing purposes • Supports advancing best practices in health care and improving health care

13. Special Member MeetingAnnual Meeting, October 2003 WSHA should do more to increase the number of Washington hospitals participating in the AHA initiative.

14. Participation By State

15. (est.) Participation Trend

16. Medicare Modernization Act

17. Medicare Modernization Act (MMA) • “Prescription Drug Law” • Seeks to expand participation with financial incentives • Based on 1st quarter, 2004 data • Qualify by: • Signing up with QNet Exchange by June 1 • Beginning data submission no later than July 1 • Completing data submission by August 2 • Submitting data on all 10 measures

18. MMA Payment Issues • Fiscal years 2005 - 2007 • Participation allows hospitals to get full market basket update • Non-participation: market basket minus 0.4%

19. Market Basket versus Market Basket Minus 0.4% • Total value for Washington: $5 million annually • Examples of individual hospital benefit (annual figures): • Mason General: $21,000 • Yakima Valley Memorial: $86,000 • Sacred Heart: $386,000 • Swedish: $492,000

20. Critical Access Hospitals • Washington has many (30) • No payment benefit • Challenges collecting data • Over 400 signed up nationwide • CMS trying to address their special concerns • Encouraged to sign up, even if not ready to submit data

21. Data Collection

22. The Specific Measures • Acute Myocardial Infarction (AMI) • Aspirin at arrival • Aspirin at discharge • Beta-blocker at arrival • Beta-blocker at discharge • ACE inhibitor for LVSD • Heart Failure • Left ventricular function assessment • ACE inhibitor for LVSD • Pneumonia • Initial antibiotic timing • Pneumococcal vaccination • Oxygenation assessment

23. The Specific Measures • The measures are fully supported in the evidence-based medical literature • Endorsed by the National Quality Forum www.nqf.org • Reviewed by expert panels • Are same as JCAHO measures • Well accepted and included in the major published guidelines • IDSA, ATS, ACC/AHA

24. Steps to Participation – Part 1 • Complete Pledge of Participation form at www.aha.org • Complete QualityNet Exchange registration at www.qnetexchange.org • Complete the Vendor Authorization form (available at www.qnetexchange.org)

25. Steps to Participation – Part 2 • Submit data to Quality Improvement Organization (QIO) Clinical Warehouse (vendor or self) • Submit validation medical records to Clinical Data Abstraction Center (CDAC) • Preview data to be publicly released • Data released late 2004 or early 2005 on www.cms.hhs.govwebsite

26. How Do We Get the Data? • It is your data, you collect and report to JCAHO • Submitted by ORYX vendor or directly to “data warehouse” • Sent via www.qnetexchange.org (encrypted) • Verified quarterly by a sample of 5 charts requested by CDAC and supplied by you

27. Poll If you signed up for the Quality Initiative, have you completed all of these steps? Yes No Not sure

28. Barriers to Participation • Data set • Gaming the data • Special problems for rural hospitals • Data transmission and display glitches • Complexity of submission process

29. Poll Have you appointed one person to be the point person on the Quality Initiative to be sure all the steps are completed? Yes No Not sure

30. Next Steps

31. Patient Surveys: HCAHPS • Hospital Consumer Assessment of Health Plans Survey (HCAHPS)www.cms.hhs.gov/hcahps • Research conducted by CMS and Agency for Healthcare Research and Quality (AHRQ) • National standard for measuring and comparing patients’ perceptions of their care • Pilot tested in 2003 • Final version available on website • First public reporting late 2004

32. HCAHPS: Hospital Position • Should be embedded in existing patient surveys • Should be a reasonable length: begin with 10 questions • Improve the questions over time • Must not impede the quality improvement work already underway • Must not be too costly, duplicative or cumbersome to implement

33. Possible New Measures • More measures in 3 conditions already included • Additional clinical info • Surgical complications • End of life care • Pain management • Scheduled procedures: normal delivery, knee replacement • Expert panel advising

34. Pay for Performance? • Quality Initiative: pay for participation • Pay for performance: • Reward high performers • Penalize low performers • Pilot program underway • Our concern: could make poor performers struggle even more

35. Special Member MeetingWSHA Annual Meeting, October 2003 Should government payment be based on quality measurements?

36. Resources

37. Qualis Health Contacts • Qualis Health • Rosa Johnson, ARNP, MN, CPHQ Manager, Medicare Operations 206-364-9700 ext. 2412 800-949-7536 ext. 2412 rosaj@qualishealth.org • Earl Kurashige, RNProject Manager206-364-9700 ext. 2342 • 800-949-7536 ext. 2342 earlk@qualishealth.org

38. Web Resources • www.qnetexchange.org • Quality Net Exchange • Sign up for data transmittal • www.qualishealth.org • Qualis Health • Assistance with quality improvement measures and processes

39. CMS Contact • Diana Migchelbrink, RN, MPHNurse Consultant206-615-2089dmigchelbrink@cms.hhs.gov

40. Web Resources: Government • www.cms.hhs.gov • Centers for Medicare and Medicaid Services • Hospital data • User’s manuals • Frequently asked questions • www.medicare.gov • Medicare quality projects • Nursing home, home health, Medicare+Choice, dialysis quality

41. Open Door Forums • Conference calls with two-way connections for live, open discussions • Personally attended by key decision makers in HHS • Visit www.cms.hhs.gov/opendoor/ for schedules and to sign up to participate • Last 30 minutes of each forum devoted to hospital quality initiative

42. WSHA Contact • Brenda Suiter, MHADirector of Rural and Public Health206-216-2531brendas@wsha.org

43. Web Resources: Hospitals • www.aha.org • American Hospital Association • Hospital position • Hospitals signed up • Tips and technical guidance • www.wsha.org • Washington State Hospital Association • Board resolution • Staff contacts

44. Questions?Comments?

45. Thank you for participating! Please fill out the evaluation.