Transcript Doing Well By Doing Good: Leapfrog Consulting Opportunties

Founded By The Business Roundtable
with Support From the Robert Wood Johnson Foundation
Update from The Pond
Greg Belden, Senior Program Associate
[email protected]
June 18, 2004
Populating the Pond
Leapfrog represents..
More than 155 large
health care purchasers
More than 34 million
Americans
More than $62 billion in
health care
expenditures
Leapfrog Members to Date
AT&T
Aetna Inc.
Allscripts Healthcare Solutions
American Century Services Corporation
American Federation of Teachers
American Medical Systems
American Re-Insurance Company
AmerisourceBergen Corporation
ArvinMeritor, Inc.
AstraZeneca
The Auto Club Group
Aventis Pharmaceuticals Inc.
Barry-Wehmiller Group, Inc.
Bath Iron Works Corporation
Becton, Dickinson and Company (BD)
Bemis Company, Inc.
Bethlehem Steel Corporation
Board of Pensions of the
Presbyterian Church (U.S.A.)
The Boeing Company
Brown Shoes
Buyers Health Care Action Group
Cargill, Inc.
Carlson Companies
Caterpillar Inc.
Ceridian Corporation
Cerner Corporation
Charter Communications
Chicago Business Group on Health
CIGNA Corporation
CITIGROUP INC.
Cleveland State University
Colorado Business Group on Health
Comerica
The Commonwealth of Massachusetts
Group Insurance Commission
Coors Brewing Company
Cummins Inc.
DaimlerChrysler Corporation
Dallas-Fort Worth Business Group on Health
Delta Airlines, Inc.
The Department of Employee Trust Funds
and State of Wisconsin Group Insurance
Board
The Doe Run Company
The Dow Chemical Company
Eastman Kodak Company
Eclipsys Corporation
Electronic Data Systems
Eli Lilly and Company
Empire Blue Cross and Blue Shield
Employer Health Care Alliance Cooperative
(The Alliance)
Employers’ Health Coalition
ESCO Technologies, Inc.
Excellus Inc.
Exxon Mobil Corporation
FedEx Corporation
Fidelity Investments
Fisher Scientific International
Flint Ink
Fleet Boston Financial
Ford Motor Company
Gateway Purchasers for Health
General Electric Company
General Mills, Inc.
General Motors Corporation
Georgia Health Care Leadership Council
Georgia-Pacific Corporation
GlaxoSmithKline
Greater Milwaukee Business Group on
Health and the Health Care Network of
Wisconsin
Hampton Roads Health Coalition
Hannaford Bros. Co.
Healthcare21 Business Coalition
HealthPartners
HealthPlus of Michigan
The Health Action Council of Northeast Ohio
Health Alliance Plan (HAP)
Health Care Payers Coalition of New Jersey
Health Language
Health Net Inc.
Horizon Blue Cross Blue Shield of New Jersey
Honeywell Inc.
HCA - Hospital Corporation of America
HIP Health Plan of New York
Indiana Employers Quality Health Alliance
International Association of Machinists and
Aerospace Workers
IBM
IDX Systems Corporation
International Paper Company
JSA Healthcare Medical Group
Johnson Controls, Inc.
Johnson County
Jostens
Kellogg Company
The KNW Group
LG&E Energy Corporation
LTV Steel Company
Land O’ Lakes
Lockheed Martin Corporation
Lucent Technologies
M-Care, Inc.
MDanywhere Technologies Inc.
MVP Health Care
MaineHealth
Maine Health Management Coalition
Maine Municipal Employees Health Trust
Maine State Employee Health Commission
Marriott International, Inc.
Massachusetts Healthcare Purchaser Group
McKesson Corporation
The Mead Corporation
Merck & Co., Inc.
Meridian Automotive Systems, Inc.
Microsoft Corporation
Midwest Business Group on Health
Minnesota Life
Minnesota Mining & Manufacturing Company (3M)
Misys Hospital Systems
Monsanto Company
Motorola, Inc.
National Education Association
National Rural Electric Cooperative Association
Nevada Health Care Coalition
New Jersey State Health Benefits Program
New York Business Group on Health
North Carolina Business Group o Health, Inc.
North Carolina Teachers’ and State Employees’
Comprehensive Major Medical Plan
Northwest Airlines, Inc.
Olin Corporation, Brass & Winchester Divisions
Oxford Health Plans, Inc.
Pacific Business Group on Health
Pediatrix Medical Group Inc.
PepsiCo
Pillsbury Company
Pitney Bowes Inc.
The Procter & Gamble Company
Promina Health System, Inc.
Quality Systems Inc.
Quest Diagnostics
Qwest Communications International Inc.
Ramsey County
Reliant Energy, Incorporated
Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital at
Hamilton
Ryder System, Inc.
Savannah Business Group
Schering-Plough Corporation
Siemens Corporation
Solutia, Inc.
South Central Michigan Health Alliance
Southern California Schools Voluntary
Employees Benefits Association
Sprint Corporation
State of Kansas Division of Personnel Services
SUPERVALU INC.
TCF Financial Corporation
TI Automotive
TRW Inc.
Target Corporation
Tennant Company
Textron Inc.
Trinity Health Plans
Tri-State Business Group on Health
Tufts Health Plan
Union Pacific Railroad
Union Pacific Railroad Employees Health
Systems
UnitedHealth Group
United Parcel Service
University of Maine System
Verizon Communications
WEA Trust
Washington Mutual Bank
Washington State Health Care Authority
Wausau Benefits, Inc.
Wells Fargo
Wiseman and Associates Financial Services, LTD
Xcel Energy
Xerox Corporation
The U.S. Office of Personnel Management (OPM); Centers
for Medicare and Medicaid Services (CMS); the Department
of Defense; and Minnesota Departments of Human Services
and Employee Relations also participate as liaison members.
Why Isn’t Quality Better?
Insurers
Providers
Not Letting Provider
Value Show Through
Not Seeing Case for
Reengineering
Purchasers
Not Buying Right,
Toxic Payment
System
Consumers
Not In the Quality
Game
Gridlock in the Health Care System:
Everyone Responsible, No One Accountable
New Thinking Needed to “Leapfrog” Gridlock
The Silent Calamity
Needless mortality and
morbidity
44,000-98,000 plus deaths
each year from medical
errors during
hospitalizations (IOM,
1999)
7,000 deaths from
medication errors alone
$17-29 million in added
costs
Number of avoidable
deaths in ambulatory care
unknown
Preventable Deaths Personalized:
The General Motors Example
US Population:
250,000,000
Preventable deaths per year:
98,000
Preventable deaths per 100,000
Americans per year:
39
GM’s covered lives:
1,250,000
GM’s preventable deaths
– Per year:
– Per day:
488!
1.3!
The Costs of Poor Quality Care
Patients, on average, receive recommended
health care only 55 percent of the time
(McGlynn et al. 2003)
30 percent of all direct health care outlays are
the result of poor care (misuse, underuse,
overuse, and waste) (Juran Institute/MBGH
2003)
Employers Fund U. S. Health Care
System – The Buck Starts Here
How Are Employers Responding to Rising Costs?
Increase employee cost
sharing
51%
Employ condition/disease
management and health
improvement programs
35%
Move to different
healthplans
Implement new delivery
systems and purchasing
models
Offer a high deductible plan
Source: Hewitt Associates, 2002
Kaiser/HRET Survey, 2003
28%
47%
20%
37%
17%
8%
12%
34%
5%
30%
36%
13%
32%
21%
35%
Primary Focus
Moderate Interest
8%
15%
26%
Minimal Interest
Less than 15% of employers think these
changes will be “very effective”.
No Interest
The Leapfrog Group’s Mission
Trigger giant leaps forward in the safety,
quality and affordability of health care by:
– Supporting informed health care decisions
by those who use and pay for health care
– Promoting high-value health care through
incentives and rewards
Leapfrog’s Mission and Vision Aligned with
IOM
Pursuit of Comparative Excellence
Measuring both hospital and
physician performance across all 6
IOM Health Care Aims
– Timeliness
– Efficiency
– Safety
– Effectiveness
– Equity
– Patient-centeredness
Purchasing Principles
Educate and inform enrollees
Compare at the provider level
Reward superior provider value
– Patient volume (select/deselect/freeze,
consumer incentives, consumer decision
support)
– Unit price (pay for performance)
– Public recognition
Highlight tangible, evidence-based quality and
safety practices (‘Leaps’)
Criteria for Safety Leaps
What’s the Difference? Leap will produce big
improvement in safety
Value Self-Evident: Leap can be appreciated by
consumers
Feasible Now: Implementation steps are doable
Easily Ascertainable: Purchaser or health plan
can see if Leap is in place
Keep the List Short: Leaps can be remembered
Initial Quality and Safety ‘Leap’ Summary
An Rx for Rx
– Computer Physician Order Entry (CPOE)
– Up to 8 in 10 serious drug errors prevented
Sick People Need Special Care
– ICU Daytime Staffing with CCM Trained M.D. live or via telemonitoring, or risk-adjusted outcomes comparison
– 29% mortality reduction (JAMA, 11/02)
The Best of the Best
– Evidence-based Hospital Referral (EHR) or risk-adjusted
outcomes comparison
– > 30% mortality reduction for 7 complex treatments
New! Overall Safety (See Appendix)
– Rolled-up score of the remaining 27 of the 30 NQF Safe Practices
(CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)
What We Stand to Gain from Initial 3
Leaps Alone?
Annual Gain Projected by Dartmouth:

 560,000-907,000 serious medication errors

 61,700 deaths

 61,700 X 5 disabilities

Potential savings $9.7 billion / year
(if fully implemented in U.S. urban hospitals)
Leap Refinement –
Creating More Sophisticated Measures
CPOE: Online evaluation tool developed by
First Consulting Group
ICU Staffing: Joint project with JCAHO to
develop risk-adjustment methodologies and
reporting program; e-ICU (telemedicine) now
applicable
Evidence Based Hospital Referral: Seeking
additional sources for outcomes reporting
Our Approach to Measure
Development & Implementation
Collaborate with measure developers
– CMS, AHA, AHRQ, NCQA, JCAHO, others
Seek consensus on breadth and content of
measurement set
Advance measures through NQF for consensus
approval
Develop rapid implementation strategy with key
partners
Leapfrog Leaps, Today and Tomorrow
Today: Hospitals
CPOE, IPS, EHR, NQF Safe Practices
Tomorrow: Hospitals and Physician Offices
Physician Office Clinical Decision Support
(See Appendix)
– Initial development coordinated with HHS,
awaiting outcome of HHS-led push toward
nationwide EMR implementation
– Minimum standards: E-prescribing, E-lab
results management, and E-care reminders
– Already in practice- CMS DOQ-IT, Bridges to
Excellence Physician Office Link
Leapfrog’s Position on EMRs
Leapfrog supports the promotion and use of
electronic data to protect patient safety and
quality and recommends that hospitals
implement CPOE systems.
An effective CPOE system rests on a broad array
of patient information and an electronic medical
record is one of the first steps to achieving this.
How Leapfrog Happens: Leaping in Unison
Purchasers
Health Plans
(MD Leadership
& Governance)
Consumers
Health Care
Delivery System
(hospitals,
physicians,
nurses
pharmacy...)
Leapfrog’s Regional Roll-Outs
Leapfrog is a national movement using targeted regions
(Regional Roll-Outs) to develop best practices, creating
early successes and learning from all stakeholders.
*23 Regional RollOut areas reach 50%
of Americans.
Regions must have:
 Effective leadership
 Competitive health
care market
 High concentration of
Leapfrog lives
*LF Regions in Green w/ exception of NV and NC
23 Roll-Out Regions
First Wave:
Second Wave:
Third Wave:

California

Dallas/Fort Worth

Maine

Seattle/Everett/
Tacoma

Colorado

Illinois

Kansas City

Hampton Roads, VA

Wisconsin

Savannah
Fourth Wave:

Metro NY & Western CT

Northern NV

Rochester NY


Massachusetts
*Raleigh/Durham/
Chapel Hill, NC

New Jersey

Central Florida

Memphis

Wichita

St. Louis

Michigan

East Tennessee

Minnesota

Atlanta
*On Hold for 2004
Collecting Hospital Level Data
Hospital survey available via The MEDSTAT Group

Ongoing voluntary Web survey

Outreach to hospitals in 23 Roll-Out areas to date, but
nationally available

Survey captures hospitals on the path

Data publicly reported, format based on feedback
from consumers and hospitals (survey and results:
www.leapfroggroup.org
Leap Applicability to Urban/Rural Hospitals
2001-2003- Leaps Apply to Only Urban Hospitals
Areas where consumers have a choice of
hospitals
Do not want to raise public expectation that rural
hospitals should prioritize the leaps
2004 and Beyond- Leaps Apply to Urban and Rural
4th Leap (NQF Safe Practices) applies to Rural
Hospitals
Rural task force working to apply initial 3 leaps to
rural hospitals
Hospitals Are Reporting from All
Over the Country
VT
MT
WY
SD
RI
NM
No Participation
Participation in
Roll-Out Regions
Participation in
Non Roll-Out Regions
Progress 2nd Quarter 2004 (cont’d)
Hospital Survey Results - Regions
Final Results 1.0
Final Results 2.0
810 hospitals nationwide
responded to Leapfrog’s
survey
1,168 hospitals nationwide
responded to Leapfrog’s
survey
558 of 949 targeted in
Regional Roll-Out areas
(58.7%)
715 of 1,188 targeted in
Regional Roll-Out areas
(60.2%)
> 60% participation in 13 of
18 RROs
> 60% participation in 17 of
22 RROs
Hospital Survey Results – Regions
CPOE
Final Version 2.0
– 5% (34) of the responding hospitals have fully
implemented CPOE - another 17% (118) will
implement by 2005
Final Version 1.0
– 5% of the responding hospitals had fully
implemented CPOE - another 22% said would
implement by 2005
Hospital Survey Results – Regions
IPS
Final Version 2.0
– 24% of responding hospitals have fully
implemented IPS
Final Version 1.0
– 21% of responding hospitals had fully
implemented IPS - another 15% said would
implement by 2004
Hospital Survey Results – Regions (cont.)
EHR % of responding hospitals meeting Leapfrog’s standard
Final Version
1.0
Final Version
2.0
CABG
12%
14%
Coronary
angioplasty/PCI
30%
12%
AAA
21%
16%
Pancreatectomy
N/A
15%
Esophagectomy
12%
8%
NICU
23%
39%
Consumers as Drivers
“Preventable mistakes” are frequent and
serious
Provider differences can be significant
Enrollee Communications Toolkit by FACCT
(NEW version available)
Engage Consumers
Heart
– KFF survey results
– Leapfrog toolkit
NEJM 12-12-2002
Engage Consumers
Health
Grades
Heart
– Leapfrog Toolkit
– NEJM survey results
Subimo
Mind
DQ
– Web Hits
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
SQC
Engage Consumers
Heart
– FACCT Toolkit
– NEJM survey results
Tier 1
Criteria
Mind
– Web Hits
Tier 2
Criteria
Wallet
Fully
Implemented
Good
Progress
Good early
stage
progress
Willing to
report
Did not
submit
information
– Co-pays, co-insurance
Number of Hospitals Responding to Leapfrog
Survey
Atlanta, GA
Dallas, TX
CPOE
ICU
CPOE
ICU
0
0
0
1
8
0
0
0
2
3
1
2
14
16
14
10
7
12
0
2
The Leap Over the Gridlock Has Begun

Rapid growth in purchasers signing on to Leapfrog’s
approach

Rapid growth in hospitals disclosing status to their
communities

Active health plan support

80% of Americans have access to information for at
least one hospital in their community

Massive education of consumers through purchasers

Market reinforcement beginning through different
channels
Market Reinforcement: “The Multiplier Effect”
Inform &
Educate
Enrollees
Member
Support &
Activation
Compare
Providers
Rewarding &
Creating
Incentives for
Quality &
Efficiency
Multipliers:
Health Plan
Products
Federal & state
purchasers
Other
distribution
channels &
partners
Improved
Value (Quality &
Efficiency)
Where We are Beginning to Make Progress
Transparency
Movement towards standardization of measures
–
The National Quality Forum
–
Medicare Modernization Act 2003: IOM to “evaluate
leading health care performance measures”
Education
Creation of consumer demand for good quality care
–
80% of Leapfrog members communicate to their
employees about medical errors and 70% about
Leapfrog
“Putting the Money Where Our Mouth IsWorking Markets Must Reward Quality”
Current reimbursement system does little to
encourage quality improvement
– 80% of Leapfrog members publicly recognize
providers but only 30% are working to reward
providers
Optimal Incentive and Reward systems
– Pay-for-Performance/Direct Financial Reward (DFR)
models
– Bonus payments/Financial awards
– Volume/Market-share Shift/Direct-to-Consumer
(DTC) models
– Tiering, Payment differentials
Lily Pads: Opportunities to Shape the Movement
CLINICIAN
HEALTH PLANS
INCENTIVES & REWARDS
BENEFITS
CONSULTANTS
REGIONAL
LEADERS
BOARD &
MANAGEMENT
COMMITTEE
LEAPS & MEASURES
ENROLLEE
COMMUNICATIONS
Paying for Performance (DFR)
Blue Cross Blue Shield of Michigan
Blue Cross of California
Bridges to Excellence
Excellus
Pay for Performance - Integrated Healthcare
Association (IHA)
Medi-Cal/Healthy Families - Integrated Healthcare
Association (IHA)
Massachusetts Health Quality Partners
Paying for Performance (DFR)
Bridges to Excellence
Physician Office Link
– Physicians can earn up
to $50 per sponsored
patient
– Must pass NCQA office
practice performance
assessment program
http://www.ncqa.org/pol/
IHA
Paying for Performance
– Common measures
– Clinical quality (40 percent)
– Patient experience (40
percent)
– Investment in information
technology (20 percent)
– Each plan comes up with
own reward methodology
Paying for Performance (DFR)
Other Initiatives
Empire Blue Cross, IBM, PepsiCo, Verizon,
and Xerox (NY)
– Hospitals: 4% bonus if meet Leapfrog’s CPOE
and ICU standards
Group Insurance Commission (MA)
– Health plans: $25-50K bonus if plans increase
admissions to Leapfrog-compliant hospitals
Anthem Blue Cross Blue Shield (NH)
– Physicians: $20 per enrollee for group
practices that finish in top quartile for quality
scores
Market-share/Volume Shift (DTC)
Closed
Networks
High
Tiered
Networks
Co-pay/ins
differentials
PBA fund
Consumer
Resistance
“COE”-type
Benefits
(travel, etc.)
Provider
Ratings
Low
Minimum
Provider Pressure
Maximum
Market-share/Volume Shift (DTC)
Provider Tiering
– Pacificare (CA), HealthNet (CA), Blue Shield (CA),
Aetna (FL, TX, WA), Patient Choice Health Care
(MN, CO, OR, MA)
Co-pay, co-insurance, premium differentials
– Hannaford Brothers
– $250 co-pay difference for employee going to
hospital meeting the volume criteria for 5 of LF’s
high risk procedures
– General Motors
– Adjusts employee premium contribution based
on plan’s cost and quality performance
Health Plans Using or Planning to Use Leapfrog Criteria in
Incentive Programs
Health Plan
Brief Description of Program
Anthem BCBS Midwest (KY, OH, IN)
Agreement between Anthem and 38 hospitals (5 in KY and 33 in OH
and IN) which links reimbursements to quality measurements (CPOE
included).
Anthem BCBS (VA)
Awards for hospitals ICU staffing an d CPOE installation
Harvard Pilgrim Health Care/ Partners (MA)
Rate increases based on patient safety measures identified by The
Leapfrog Group as well as other performance measures
Empire BCBS (NY)
Awards hospitals bonuses for meeting CPOE and IPS Leaps
BCBS (IL)
Helps hospitals pay for electronic intensive care units
BCBS (MI)
Rewards hospitals for including automated entry systems for
prescriptions;
BS (CA)
Tiers hospitals on cost effectiveness and good quality scores (uses
LF)
HealthNet (CA)
Incentive program modeled after Empire BCBS’s
Independence BC (PA)
Rewards hospitals that meet LF standards and JCAHO’s performance
criteria
Pacificare (CA)
Tiers hospitals based on a number of variables including LF’s safety
measures
Tufts/ Partners (MA)
Contract with Partners' hospitals to provide financial bonuses for
implementing "electronic systems" that improves the safety and
efficiency
Tufts (MA)
Tiers hospitals using quality and efficiency measures including CPOE
and IPS
Regence BCBS (WA)
Has plans to incent hospitals if fully-compliant with LF Leaps
Purchasers Using or Planning to Use Leapfrog Criteria in
Incentive Programs
Purchaser
Brief Description of Program
Pacific Business Group on
Health (CA)
Places 2% of health plans’ premiums at risk- must meet targets to obtain full
amount, one target being support of LF implementation
IBM, PepsiCo, Verizon, Xerox
(NY)
Cooperate and pools funds with Empire BCBS to reward hospitals that meet
the CPOE and IPS standards
Hannaford Brothers (ME)
Applies an additional co-pay if an employee of theirs attends a hospital that
does not meet the volume criteria for 5 out of the 7 LF high-risk procedures
Wisconsin Employee Trust
Funds (WI)
Plans to evaluate health plans using HEDIS, The Leapfrog's recommended
patient safety practices, and eventually the collecting and reporting of data
around NQF's safe practices
Group Insurance Commission
(MA)
The GIC has agreed to give their health plans financial bonuses if they meet
standards for increasing admissions to Leapfrog-compliant hospitals
What’s in the Pipeline?
AHRQ Incentive and Reward Pilots
Pilot
Type of Incentive
GE and Verizon; Albany, NY
DFR and/or DTC
Boeing; Seattle, WA
DTC- Payment
Differential
Maine Health Management
Coalition; Portland, ME
TBD
Healthcare 21; Eastern TN
DTC- Tiering
Market-share/Volume Shift (DTC)
Creating Differential Hospital Insurance for
Employees – The Boeing Company
Part of collective bargaining agreement with two largest
unions
Effective July 1, 2004, union employees and early retirees
will obtain 100% coverage after deductible for services
provided by a Leapfrog-compliant hospital
Hourly employees hospitalized in facilities that do not meet
the Leapfrog safety practices will obtain 95% coverage after
deductible
This benefit design will remain in place until July 1, 2006
when a new collective bargaining agreement becomes
effective
What’s in the Pipeline?
Leapfrog’s E 2 (Effectiveness and Efficiency)
Hospital Rewards Program- Piggy-backing on
CMS-Premier “Pay-for-Performance” Demo
– Actuarial analysis shows win for members
– Data collection method already in place
– No new measures
– Plans can implement quickly for self-insured
or fully-insured customers
– Can implement nationally or at local level
– Can expand to other GPOs/Hospital groups
Other Incentives and Rewards
Initiatives/Leverage Points
*I&R Toolkit
*I&R Compendium
Health Plan User Groups
*Standard Health Plan Contract Language
*eValue8 Common RFI
*Update of Economic Implications of original three leaps
Malpractice Study
* Found on Leapfrog Web site: http://www.leapfroggroup.org
Beginning to Leap Over Gridlock but Gaps
Still Exist
Transparent Market- nationally standardized measures of
quality and efficiency
Market Reinforcement- reward quality and efficiency and
better demonstrate business case
Engage Consumers- aware of variation, mechanisms for
timely and effective delivery of information, financial
incentives
Engage Purchasers- including government- sufficient tools
and critical mass
New health plan products
APPENDIX
Appendix A: NQF Safe Practices
27 Safe Practices from the National Quality
Forum Safe Practices Consensus Report
(May 2003): The report is available at
www.qualityforum.org
Applicable to urban and rural hospitals
Rolled up measure of patient safety for
release to public in August 2004
27 Safe Practices
1. Create a healthcare culture of
safety
2. Ensure an adequate level of
nursing care
3. Pharmacists available for
consultation with prescribers on
medication ordering,
interpretation, and overall
medication use process
4. Read backs to the prescriber
5. Standardized abbreviations and
dose designations
6. Patient care summaries or other
similar records should not be
prepared from memory
7. Care information, especially
changes in orders and new
diagnostic information, is
transmitted in a timely and clearly
understandable form
8.
Patient or legal surrogate can
recount informed consent
discussion
9. Patient's preference for lifesustaining treatments
prominently displayed in record
10. Standardized protocol used to
prevent the mislabeling of
radiographs
11. Standardized protocols used to
prevent wrong-site or wrong
patient procedures
12. Evaluate and provide
prophylactic treatment for
patients at high-risk of acute
ischemic cardiac event during
surgery
27 Safe Practices, con’t
13. Evaluate each patient upon
admission, and regularly
thereafter, for the risk of
developing pressure ulcers
14. Evaluate at admission (and
treat), and regularly thereafter,
for risk of deep vein thrombosis
(DVT)/venous
thromboembolism(VTE)
15. Utilize dedicated anti-thrombotic
(anti-coagulation) services
16. Assess at admission, and
regularly thereafter, patients for
risk of aspiration.
17. Use effective methods of
preventing central venous
catheter-associated blood
stream infections
18. Assess risk of surgical site
infection; implement antibiotic
prophylaxis and other measures
19. Reduce risk of renal injury based
on the patient’s kidney function
evaluation using standardized
protocols
20. Evaluate risk of malnutrition, at
admission and thereafter; employ
clinically appropriate strategies to
prevent malnutrition
21. When utilizing pneumatic
tourniquet evaluate patient risk
for an ischemic and/or thrombotic
complication, and utilize
appropriate prophylactic
measures
22. Decontaminate hands with either a
hygienic hand rub or by washing
with a disinfectant soap after
contact with patient or patient
objects
23. Vaccinate healthcare workers
against influenza
27 Safe Practices, con’t
24. Keep workspaces where
medications are prepared
clean, orderly, well lit
25. Standardize the methods
for labeling, packaging, and
storing medications
26. Identify all "high alert"
drugs (e.g., intravenous
adrenergic agonists and
antagonists, chemotherapy
agents, anticoagulants and
anti-thrombotics,
concentrated parenteral
electrolytes, general
anesthetics, neuromuscular
blockers, insulin and oral
hypoglycemics, narcotics
and opiates)
27. Dispense medications in unitdose or, when appropriate,
unit-of-use form, whenever
possible
Appendix B: Physician Office Clinical
Decision Support
Rationale: E-Prescribing
Medication errors affecting as many as 9% of
prescriptions.
E-prescribing systems have the potential to
improve quality and safety by:
– Eliminating legibility problems
– Reducing the occurrence of drug
interactions, dosage errors, and other
adverse effects by guiding prescribing
based on computerized assessment of
patient and medication information
Specifications: E-Prescribing
Physician office adopts and uses an electronic
system which includes all of the following:
 Decision support based on drug reference
information
 Patient-specific decision support database
which includes age, weight, medications
prescribed by that office, diagnoses, allergies,
specified lab results, and electronicallyavailable formulary information; inclusion of
medications prescribed by other physicians is
encouraged, but optional
 Printing of a paper prescription or its NCPDPcompliant electronic transmission to the
pharmacy
Rationale: E-Lab Results Management
Errors in managing lab results are common.
E-lab results management systems have the
potential to improve quality and safety by:
 Making a practitioner aware if lab test
results which have been received have not
been reviewed and/or shared with the
patient
 Reducing unnecessary test ordering by
giving a practitioner easier access to
previous lab test results
Specifications: E-Lab Results Management
Physician office adopts and uses an electronic
system which includes all of the following:
 Tracking whether results have been reviewed
by the practice
 Tracking whether results have been
communicated to the patient, either
electronically or via telephone or regular mail
 Storage and retrieval of LOINC-compliant lab
results reports (excepting microbiology) in
database-structured format
Rationale: E-Care Reminders
Preventive services, or services recommended
for chronic conditions, are underutilized. E-care
reminder systems have the potential to improve
quality and safety. Examples include:
 Increase vaccination rates
 Improved screening for breast cancer,
colorectal cancer, cervical cancer, and other
diseases
 Improved cardiovascular risk factor reduction
 Smoking assessment and counseling
E-Care Reminders, con’t.
 Dietary assessment and counseling
 Improved management of hypertension
 Improved management of diabetes
 Increased detection of medication errors
and adverse drug events
Specifications: E-Care Reminders
Physician office adopts and uses an electronic
system which includes all of the following:
 Patient-specific database which includes age,
gender, diagnoses, treatment codes, lab test
results, and medications documented by a
clinician, AND
 Specified reminders for clinicians drawn from
current US Preventive Services Task Force
and other nationally recognized care
guidelines (Appendix B)
Specifications: E-Care Reminders (2)
The electronic system enables all of the
following clinician reminders:

Patients needing guidelines-based
services at the time of patient contact

Patient lists for outreach
communications to patients who require
scheduling for guideline-based services

Generation of periodic reports of
guideline-adherence rates for the
physician office’s patient population as a
whole