AHRQ Report Provides High Performance Work Practices to Maximize Quality

The Agency for Healthcare Research and Quality (AHRQ) has released a report describing how healthcare entities can attract, hire, develop, and retain staff members who can contribute to higher healthcare quality. The report, titled Using Workforce Practices to Drive Quality Improvement, provides four high-performance work practice (HPWP) models that can be implemented in a facility.

The HPWPs focus on practices such as rewarding performance, providing career development opportunities, aligned decision-making, and ensuring that leaders are developed to carry out an organization's goals and mission.

The report can be found here:
http://www.ahrq.gov/qual/workforceguide.htm


Source: AHRQ

State Insurance Commissioners Vote to Approve More Stringent Rules

The National Association of Insurance Commissioners voted unanimously to endorse standards requiring that "80 percent of premium revenue be spent on medical care and 'activities that improve health care quality' for patients." This requirement was set in place by health reform legislation.

The standards set limits on what revenue spending is defined as improvements to health care quality, and what is considered to be compensation or administrative spending. The goal of the standards is to make insurance companies function more as providers of healthcare and less as for-profit companies.

Secretary of Health and Human Services Kathleen Sebelius is expected to take the recommended standards and propose them as a new regulation for insurance companies. Opponents of the recommendations argue that they will negatively disrupt the insurance industry by forcing companies out of business and reducing consumer choice.


Source: The New York Times
http://www.nytimes.com/2010/10/22/health/policy/22insure.html?_r=4&emc=tnt&tntemail0=y

Study Shows Patients Are Provided with Insufficient Quality Physician Quality Data

Patients are encouraged to select physicians based on certain quality characteristics; however, a recent study reveals that patients don't have access to the information that should be used in order to make decisions on healthcare providers. This finding can be found in the September 13, 2010 issue of the American Medical Association's Archives of Internal Medicine.

The report states that the profile information given to the public to assist with the selection of a doctor does not strongly correlate with a doctor's ability to provide quality clinical care. For example, malpractice claims were found to be a weak indicator of performance. The study noted that there are three characteristics that are associated with higher performance --"female sex, board certification, and graduation from a domestic medical school;" however, even this data only indicated marginal differences in quality.

The report also notes the need for greater public access to physician quality data, so patients can make well-informed choices regarding their care. As MSPs know, one must search beyond the basic information on a physician's training to reveal the true level of quality that the physician can provide.

To view the report's abstract, click here (payment required for access to the full article): http://archinte.ama-assn.org/cgi/content/abstract/170/16/1442?view=short&fp=1442&vol=170&lookupType=volpage


Source: Archives of Internal Medicine

MSPs Should Be on the Lookout for ACOs

A new acronym (ACO) to keep on our radar screen. The goal of such organizations is to keep patients healthy AND be cost-efficient. According to BNA, accountable care organizations "are designed to keep patients healthy and out of intensive care settings, while simultaneously shifting reimbursements to pay based on the achievement of top performance goals that drive improved patient outcomes and cost-effectiveness."

The Centers for Medicare & Medicaid Services (CMS) is working on draft regulations that will define what constitutes an ACO. The CMS-regulated ACO program is set to begin in 2012. Currently, there are some ACO models are emerging from Physician Group Practice organizations.

The purpose of the ACO program is to reward providers with higher reimbursement if they attain positive patient outcomes and are successful at promoting patient wellness. The idea is that it is more costly to reimburse providers for the treatment of illnesses; therefore, quality healthcare can be made more cost-efficient if they strive for the maintenance of patients' good health.

It will be interesting to see whether or not MSPs are asked to assist with monitoring "top performance goals" as part of the final ACO rules.


Source: BNA

Anesthesiologist Sentenced for Research Fraud

Dr. Scott Reuben, a Massachusetts anesthesiologist, was sentenced to six months in prison after pleading guilty to the fabrication of data in a research study.

Reuben admitted to providing false data for a pain management study he performed for Pfizer, Inc. It was later discovered that he had fabricated data in several studies, dating back to 1996. Baystate Medical Center in Springfield, MA stripped him of educational and research duties after this discovery.

Reuben's defense claimed that his undiagnosed bipolar disorder made him unable to prevent his wrongful behavior.

This example highlights the need to take some caution when relying on research studies, and for medical facilities to monitor the research conducted by members of their staff.


Source: BNA

Study Shows Limiting Surgical Training Hours May Hurt, Not Improve Care

A study conducted in a Swiss hospital shows that most residents and surgical supervisors believe that limiting surgical training hours has a negative effect on training and performance. In Switzerland, residents are limited to 50 hour workweeks. In the US, residents have been capped at 80 hours a week since 2003.

Limiting surgical residents' working hours has been a recent strategy used to increase safety. It is believed that limiting hours decreases the likelihood that medical errors will be made by a tired resident. Respondents in the Swiss study stated that while their quality of life increased with less work hours, they felt that they did not have the adequate time to learn necessary skills and build endurance for long surgeries.

The study did not take into account whether or not nurses and patients perceived a lower quality of care.


Sources: Health Care Advisory Board, Medpage Today
http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/20797

VA Limiting Surgeries to Improve Care and Quality

Officials at the Department of Veterans' Affairs have announced that surgeries at some VA facilities will be limited based on the agency's "surgery complexity initiative." The initiative grades VA hospitals based on their medical staffing, equipment, and diagnostic capabilities. The complexity of surgical procedures are compared against the grade received by a facility to determine if the facility is capable of performing certain procedures.

66 facilities have been approved to perform complex procedures (cardiac, brain pancreas surgeries, etc.). 33 have been approved for intermediate procedures (joint replacement, colon ressections, etc.). 13 facilities are limited to standard procedures (hernia repair, ear, nose, and throat surgeries, etc.).

The VA said that they will assist with transportation to facilities if a patient needs to go to a distant hospital for a procedure due to the limitations. The VA said that this system is part of its response to improve quality after problems were discovered at the VA hospital in Marion, IL.


Source: Army Times
http://www.armytimes.com/news/2010/05/military_VA_surgeries_050610w/

Angie's List Encourages Patients to Make Sure Their Healthcare Providers Are Licensed

Angie's List, a consumer-focused website that allows people to post review services and contractors, recently released an article encouraging patients to check to make sure their healthcare providers are practicing under a current license.

91 percent of respondents said that it is "crucial that their health care providers are licensed," yet most respondents do not check for licensure themselves.

The article presents several interesting situations of unlicensed medical professionals and the potential dangers of having these providers see patients. The article does recognize that many of the "unlicensed" professionals are simply professionals who have let their license expire. Matt Haddad, CEO of Medversant, noted the importance of seeing a properly credentialed provider.

This article is good at highlighting the value of the MSP from the consumer perspective. Patients should not have to ask their providers for proof of licensure when they enter a hospital or call an office to schedule an appointment. They should be able to seek care, knowing that their provider is licensed and competent. It is our job as MSPs to keep sanctioned providers away from patients, and to ensure that providers know the importance of licensure and do not let it lapse.

To read the full article, click here: http://magazine.angieslist.com/Articles/2010/May/NATIONAL/Check-medical-license-before-getting-checked-out.aspx


Source: Angie's List

HFAP Implements New Patient Safety Standards

This year, Healthcare Facilities Accreditation Program (HFAP), based in Chicago, IL, developed patient safety standards based on the National Quality Forum’s (NQF) 34 Safe Practices.
The elements that contribute to patient safety as defined by the NQF are:

• Leadership must ensure structures are in place for organization-wide awareness and compliance with safety measures including adequate resources and direct accountability.
• Measurement, analysis, and feedback must track safety and allow for interventions.
• Team-based patient care with adequate training and performance improvement activities must be organization-wide.
• Safety risks must be identified continuously and interventions taken to reduce patient risk.

HFAP has already implemented several standards that promote the 34 Safe Practices of the NQF. The 34 Safe Practices address areas such as leadership, medication reconciliation, and wrong-site surgery.

For more information, visit HFAP's website at: http://www.hfap.org/.

Improper Background Checks by Staffing Firms Are Connected to Hiring of Unfit Temporary Nurses

A report from ProPublica and The Los Angeles Times shows that hospitals may be using temporary RNs who are unqualified because of poor screening by staffing firms.

The report shows that many nurses with criminal histories, histories of poor performance, and improper credentials were able to acquire employment with a hospital because the staffing agency failed to perform a thorough background check or listen to warnings from other facilities. Some nurses were able to avoid being caught with unfit qualifications by moving to a new hospital before an investigation into their performance background could be performed.

Some attribute the rise in unqualified nurses to the nursing shortage. With hospitals needing to quickly hire nurses to meet their staffing needs, some facilities are relying solely on the background check performed by the staffing agency, without performing their own check.

While there are many quality temporary staffing agencies out there, this should also serve as a call to hospitals to do their due diligence when working with one. Your facility should always try to verify the credentials of temporary nursing staff. If this is not possible, then make sure that the staffing agency you work with has a proper credentialing system in place.

There may be a staffing shortage, but it is better to take the time to hire quality staff, than to meet staffing numbers with unqualified individuals.

To read the full article, click here:
http://www.latimes.com/news/local/la-me-nurses6-2009dec06,0,1174984.story.


Source: The Los Angeles Times

ABMS Develops New Assessment Requirements

The ABMS Maintenance of Certification program will require boards to implement processes described as promoting “continuous professional development and assessment," replacing the traditional re-certification exams currently taken by physicians.

Board processes for documenting continuing education and self-assessment requirements must be implemented by 2011. Processes for documenting practice-based assessment and quality-improvement requirements must be implemented by 2011.

Member boards must also require physicians to undergo a patient safety self-assessment program by 2012. The assessment will focus on the communication skills of physicians who have direct contact with patients and with peers. Communication skills will be measured using the Consumer Assessment of Healthcare Providers and Systems survey (CAHPS) and other tools.

Source: American Board of Medical Specialties
http://www.abms.org/News_and_Events/Media_Newsroom/Releases/release_NewMOCStandards_03262009.aspx

Summit Calls for Greater Diversity and Patient Focus in Medical Education

A panel of participants in a medical education summit sponsored by the Josiah Macy, Jr. Foundation urged medical educators to take advantage of the coming expansion in the number of medical schools to promote diversity in the profession and to push for a greater focus on professionalism in the curriculum.

The panel emphasized the need to address the high medical school debt incurred by students, which may be keeping many competent individuals from considering medicine as a career path.

The panel also pushed for greater emphasis on patient care and safety, teamwork, problem-solving, and public health issues within the traditional medical school curriculum. By doing so, medical students will be more prepared for the needs of the community once they graduate and are practicing physicians.

The full findings of the panel are published in a report titled "Revisiting the Medical School Educational Mission at a Time of Expansion," by the Josiah Macy, Jr. Foundation.

The Josiah Macy, Jr. Foundation is a private organization that supports programs to improve the public health focus in medical education and increase the representation of minorities in the health profession.

Source: MedPage Today
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12689

OIG Releases Two Studies on Adverse Event Reporting

The Department of Health and Human Services Office of the Inspector General (OIG) has released two studies on how hospitals and states are collecting and utilizing data on adverse events.

In the study titled, Adverse Events in Hospitals: Overview of Key Issues, the OIG identifies adverse events as "any harm to a patient as a result of medical care, such as infection because of contaminated equipment." The study also notes that while better reporting of adverse events will lead to a higher quality of care, there are several barriers to proper reporting. For example, the report states that hospital staff may be too busy and forget to report an incident. Others may be hesitant to report an adverse event, fearing that it will lead to legal action.

The OIG's second study, Adverse Events in Hospitals: State Reporting Systems, examined the 27 states that have established adverse event reporting systems. Although each state has a different reporting system, they have all been using their data to make quality improvements in their healthcare systems.

To read the OIG's studies, click here:

Adverse Events in Hospitals: Overview of Key Issues
http://www.oig.hhs.gov/oei/reports/oei-06-07-00470.pdf

Adverse Events in Hospitals: State Reporting Systems
http://www.oig.hhs.gov/oei/reports/oei-06-07-00471.pdf

Source: BNA

More States Moving Toward Health IT Implementation

According to a report by the National Conference of State Legislatures (NCSL), more states are moving toward health IT (HIT) implementation, recognizing its impact on improving the quality of care, while lowering costs.

The report shows that between 2007 and 2008, more than 370 HIT bills were introduced at the state level, three times more than the number introduced between 2005 and 2006.

Supporters of HIT cite improvements it can make in patient record-keeping and the prevention of duplicate records.

Source: Healthcare IT News
http://www.healthcareitnews.com/story.cms?id=10590&fromRSS=true

AHIC Advises HHS to Build Regulatory Compliance of EHRs

The American Health Information Community (AHIC) issued a recommendation to the Department of Health and Human Services (HHS), urging HHS to promote electronic health records (EHR) compliance.

AHIC encourages the creation of EHR templates to reduce redundancy in information collection. AHIC also encourages HHS to convene a panel of experts who can determine what licensing, regulatory, quality, and payment data should be included in EHR templates. These templates would be stored in a database accessible to the public.

To read more on AHIC's recommendations, click here:
http://www.govhealthit.com/online/news/350669-1.html

Source: Government Health IT

AHRQ Launches Quality Measurement Clearinghouse

The Agency for Healthcare Research and Quality (AHRQ) has launched the National Quality Measures Clearinghouse (NQMC), a repository of the quality measurements and measure sets currently used by the Department of Health and Human Services for reporting data and determining payment.

Through this Web site, the public can access healthcare quality measures and apply them to their organizations when desigining their own policy and quality initiatives. The measures are updated on a weekly basis.

To access the NQMC, click here:
http://www.qualitymeasures.ahrq.gov/