Transcript Slide 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 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. Stakeholder Response to Patient Safety Regulatory Mandatory requirements for accreditation High Quality Safe Care Government Monitor provider organizations through mandatory and voluntary reporting. Institution Initiatives Financial Issues Specific initiatives identified by this institution. Do more with less Payers Employers Leapfrog Provide incentives to providers that use tools to increase safety and can demonstrate performance. IHI AHRQ ISMP ASHP NQF 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 The Joint Commission www.jointcommission.org National Quality Forum www.qualityforum.org 2007 2003 2003 2003 2005 www.hospitalcompare.hhs.gov and www.medicare.gov Hospital Quality Alliance (HQA) http://www.qualitynet.org 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 Quality Indicators National Goals Measure Development NQF Endorsement Measure Selection Data Collection, Aggregation, Verification Public Reporting and Accountability Quality Improvement Were the goals achieved? Growth of Publicly Reported Measures 50 2004 – Annual Payment Update of .4% tied to submitting 10 HQA measures 45 2007 – Annual Payment Update of 2% tied to submitting 21 HQA Measures and CMS able to add additional measures; HCAHPS next. Number of Measures 40 35 30 25 20 15 10 5 0 Annual Payment Update Hospital Quality Alliance Joint Commission CMS Performance (Core) Measures Acute Myocardial Infarction (AMI) Heart Failure (HF) Pneumonia (PN) Pregnancy and related conditions (PRC) Surgical Infection Prevention (SCIP) Acute Myocardial Infarction Thrombolytics Drugs at discharge Time to administration Aspirin ACE inhibitor or ARB for left ventricular systolic dysfunction Beta blocker Adult smoking cessation counseling 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 SCIP Cardiac Infections Surgical site infections Respiratory Beta blockers Post-operative pneumonia Venous thromboembolism Prophylaxis 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 Anticipated Payment Scenario Condition X Condition X Condition X 1st Decile 2nd Decile Top Performance Threshold 1st Decile 1st Decile 3rd Decile 2nd Decile 4th Decile 5th Decile 3rd Decile 2nd Decile 3rd Decile 6th Decile 4th Decile 7th Decile 5th Decile 8th Decile 9th Decile 6th Decile 4th Decile 7th Decile 5th Decile 8th Decile 10th Decile Hospital 9th Decile 6th Decile Payment Adjustment Threshold 7th Decile 10th Decile Hospital 8th Decile 9th Decile 10th Decile Year One Source: Premier, Inc Year Two Year Three Hospital 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 ASHP Website and 2015 Crosswalk www.ashp.org/qii What’s Next? Tight glycemic control Asthma care Stroke management Diabetes ? What are we doing? 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