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					  Medicare QIO
    Update


        Mitzi Daffron
Center Director, Medicare QIO
         Operations
     Health Care Excel




                                HCE 4/06
Medicare QIO’s 8th Scope of Work

• Many changes
  – New settings
  – New topics
  – New partners


• But, the more things change, the
  more they remain the same!

                                     HCE 4/06
                  Settings

•   Nursing Homes
•   Home Health Agencies
•   Hospitals
•   Physician Practices
•   Prescription Drug Plans
•   Medicare Advantage Prescription Drug
    Plans

                                           HCE 4/06
                 Nursing Homes

• Focus on culture
  change
• Target setting
• Continued work on
  care measures
  –   Pressure Ulcers
  –   Chronic Pain
  –   Physical Restraints
  –   Depression

                                 HCE 4/06
             Nursing Homes

• Currently working intensively with 84
  nursing homes in Indiana
• Of the more than 500 nursing homes in
  Indiana, 48% have set internal targets for
  pressure ulcers and physical restraints
• Over 50 nursing homes have collected and
  reported staff and resident surveys, as well
  as a baseline CNA turnover rate

                                                 HCE 4/06
Home Health

      • Focus on
        – decreasing acute care
          hospitalization
        – target setting
        – improving the
          management of
          dyspnea
        – improving
          immunization care
          processes
        – culture change
                              HCE 4/06
                 Home Health

• Twelve agencies have committed to work on
  implementation of some form of telehealth and an
  aspect of organizational culture
• Thirty-one agencies are working on two publicly
  reported outcomes, including acute care
  hospitalization, along with a measure of their
  choice
   – 32% of these are working on Improvement in
     Dyspnea
• Total of 86 agencies currently working with the
  QIO on at least one measure
                                                    HCE 4/06
    Acute Care Prospective Payment
           System Hospitals
       Appropriate                    Surgical Care           Systems Improvement
      Care Measures                Improvement Project         and Organizational
          (ACM)                          (SCIP)                  Culture Change


             AMI                  Surgical Site Infection     Computerized Physician
              HF                Venous Thromboembolism         Order Entry (CPOE)
             PN                  Ventilator Associated PN          Bar Coding
(Starter set of 10 measures)   Cardiovascular Complications        Telehealth


                                 Fistulas for Hemodialysis




                                                                                       HCE 4/06
       Rural and/or Critical Access
             Hospitals (CAH)
                       Clinical Performance Quality Measures
                          and Organizational Safety Culture


                 CAH                       Rural Organizational Safety Culture Change
    Quality Improvement Measures


Submitting data on 15 Clinical Measures         Agency for Healthcare Research
                                                      and Quality (AHRQ)
                                                 Patient Safety Culture Survey




                                                                                  HCE 4/06
            Physician Practice

• Support Physician
  Voluntary Reporting
  Program (PVRP)
• Promote improvement
  in preventive and
  disease-based care
  processes
• Recruit at least 5% of
  primary care practices
  to work on
  implementing
  electronic health              HCE 4/06
You Can’t HANDLE the Paper!




                              HCE 4/06
Physician Practice

         • Promote physicians
           reporting data to clinical
           warehouse
         • Assist physician
           practices in adopting
           care management
           processes
         • Increase number of
           practices producing and
           using electronic clinical
           information
                                  HCE 4/06
            Physician Practice
• Currently have 114 practices recruited that
  are planning to adopt an EHR within the next
  18 months
• PVRP has raised interest, particularly in
  hospital medical staff meetings—program
  allows physicians to start reporting prior to
  adopting an EHR
• Statewide activities to promote preventive
  care include a new partnership with the Area
  Agency on Aging
                                              HCE 4/06
        Underserved Population

• Statewide—improve
  care for diabetes
• Statewide—improve
  use of preventive
  services
  (mammography and flu
  and pneumonia
  immunizations)
• Promote CLAS
  standards
• Cultural competency
  education                      HCE 4/06
       Underserved Population
• Eight practices that serve a large
  underserved population have committed to
  implementing an EHR in the next 18
  months
• Out of 50 needed, 42 providers have
  agreed to complete education through the
  Office of Minority Health Cultural
  Competency Program
• Key partnerships continue with the Minority
  Health Coalitions, Faith Health Initiative,
  and the Health Disparity Coalition            HCE 4/06
Pharmacy/Part D Benefit

            • Environmental scan of
              e-prescribing in the
              state
            • Development and
              implementation of a
              pharmacy project by
              August 2006
            • Work with Prescription
              Drug Plans and
              Medicare Advantage
              Prescription Drug
              Plans                HCE 4/06
       Pharmacy/Part D Benefit

• CMS-approved project in Kentucky,
  Indiana, and Ohio (in partnership) is on
  “Improving Pharmaceutical Care in Long
  Term Care Facilities”
• QIO is currently meeting with LTC
  pharmacies, LTC facilities, and prescription
  drug plans to develop a detailed project
  plan
                                             HCE 4/06
           Beneficiary Protection

• Beneficiary complaints
  – IOM report
  – Grassley investigation




                                    HCE 4/06
Hospital Payment Monitoring Program

• Focused one-day stay project in Indiana
  – DRGs 132, 141, 143, 182, and 183
  – These 5 DRGs account for 82.3% of claims
    submitted for the 12 cardiac-mimicking DRGs
• Compliance focus area for CMS




                                              HCE 4/06
              Pay-for-Performance
• Pay-for-Performance (P4P) is
                                                P4P is a tsunami
  here to stay                                 building offshore in
• One-sixth of the nation’s                          a sea of
                                               stakeholder unrest,
  economy is at stake                           threatening those
                                                   who are not
• Providers should act now to                       prepared.
  assure they do not suffer from
                                                   AMA 2004
     • Reduced payment rates
     • Poor public image or impaired
       reputation
     • Reduced demand for services

     • Taken from the National Committee for
       Quality Health Care
                                                                      HCE 4/06
   What is Pay? What is Performance?
• Pay                            • Performance
                           • Common performance dimensions:
Payers link some portion
  of a provider’s               • Clinical quality (medical
  payments to                     process)
  improvements in               • Patient outcomes
  performance                   • Safety
                                • Satisfaction
                                • Cost/efficiency
                                • Use of IT

                           • Current P4P programs draw heavily on
                             data from claims or administrative files
                             to assess performance


                                                                   HCE 4/06
            Focus on Common Conditions
                      Hospital    CMS Public
                                                  CMS/ Premier
              JCAHO   Quality    Reporting (all                   Leapfrog
                                                  Demonstration
                      Alliance     hospitals)
   Heart
                X        X             X               X             X
Attack/ AMI
   Heart
                X        X             X               X             X
  Failure

Pneumonia       X        X             X               X             X

 Surgical
 Infection      X                      X               X             X
Prevention
Pregnancy/
                X                                                    X
 Newborn

 Hip/Knee                                              X



                                                                         HCE 4/06
Private purchasers are in the lead, but Medicare is
                not far behind…

• Leapfrog categorizes over 90 private insurer P4P
  programs
• CMS has numerous P4P demonstrations
• State Medicaid programs are beginning P4P
  experiments
• Most P4P is regional, but national programs are
  emerging



                                                     HCE 4/06
       Questions???
Medicare QIO Provider HelpDesk
        1-800-300-8190
        Mitzi Daffron—
   mdaffron@inqio.sdps.org


                                 HCE 4/06

				
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