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Issue 5: Industry News - February 2017
Table of Contents
- AHA: MAP Must Advocate for Streamlined CQMs, Care Improvement
- Combining Qualitative and Quantitative Operational Research Methods to Inform Quality Improvement in Pathways that Span Multiple Settings
- HHS Finalizes New Medicare Alternative Payment Models to Reward Better Care at Lower Cost
- NQF Provides Guidance to Help Reduce Variation in Healthcare Quality Measures
- Reduced Emergency Department Utilization by Patients with Epilepsy Using QI Methodology
AHA: MAP Must Advocate for Streamlined CQMs, Care Improvement
EHR Intelligence (01/17/2017) Heath, Sara
In a letter to the co-chairs of the Measure Applications Partnership (MAP), a subgroup under the National Quality Forum, the American Hospital Association (AHA) asserts that MAP should advocate for more streamlined clinical quality measures (CQMs) that improve care value for patients while also alleviating burden for providers. Specifically, AHA warns against valuing electronic clinical quality measures (eCQMs) over other measures. Regarding eCQMs, AHA Senior Vice President for Public Policy Analysis and Development Ashley Thompson says, "While theoretically these measures should reduce the effort entailed in manual chart abstraction, introducing additional or converting existing measures to be eCQMs incorrectly assumes that the measures work as intended and that all electronic health record (EHR) products support the reporting of those measures." According to the AHA, hospitals struggle to obtain eCQMs, and they often require significant workarounds to collect them. Furthermore, providers collecting eCQMs are hampered by a lack of fully interoperable EHR systems. "Because of questions concerning the feasibility and accuracy of eCQMs, the AHA urges restraint in adding or converting measures into eCQMs," says Thompson. AHA also recommends that MAP not advocate for any duplicative measures included on the Measures Under Consideration list, asserting they will likely add to the provider workload without increasing any value in patient care.
Combining Qualitative and Quantitative Operational Research Methods to Inform Quality Improvement in Pathways that Span Multiple Settings
BMJ Quality and Safety (01/06/2017) Crowe, Sonya; Brown, Katherine; Tregay, Jenifer
A goal of many health systems is improving integration and continuity of care across sectors despite resource constraints. To address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods, health systems can use qualitative operational research methods of problem structuring. In this study, British researchers sought to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD). Soft systems methodology was used to examine changes to services from the perspectives of community, primary, secondary, and tertiary care professionals and a patient group. A classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualization designed to inform service improvement within the context of limited resources. By identifying the key features of services for infants with CHD that were relevant to service improvement, the researchers were able develop a "Rich Picture." They used the Rich Picture and a graphical summary of the CART analysis to inform discussions about targeting interventions to particular patient risk groups and to reach consensus on targeted recommendations for quality improvement. The researchers say their findings show that using a combination of qualitative and quantitative operational research methods is one approach to working with multiple perspectives systematically, one that merits additional consideration.
HHS Finalizes New Medicare Alternative Payment Models to Reward Better Care at Lower Cost
HHS News Release (12/21/16)
New Medicare alternative payment models, finalized on Dec. 20, 2016, by the Department of Health and Human Services (HHS), aim to continue the government's progress in reforming how the healthcare system pays for care. Under these new approaches, hospitals and clinicians will be incentivized to work together to avoid complications, avoid preventable hospital readmissions, and speed patient recovery. The announcement finalizes new policies that improve cardiac care via three new payment models that will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation. To improve orthopedic care, one new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture beyond hip replacement. HHS is also finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016. To encourage more practices, particularly small ones, to advance to performance–based risk, the new Medicare Accountable Care Organization (ACO) Track 1+ Model will have more limited downside risk than in Tracks 2 or 3 of the Medicare Shared Savings Program. The model also allows hospitals to participate in this new ACO model. Stakeholders, including physician groups, have asked that this type of ACO model be added to the portfolio of options. The approach will enable approximately 70,000 clinicians to qualify for Advanced Alternative Payment Model incentive payments in 2018.
NQF Provides Guidance to Help Reduce Variation in Healthcare Quality Measures
NQF News Release (02/05/17)
The National Quality Forum (NQF) has released guidance on reducing unnecessary variation in healthcare quality measures so that measurement can be more uniform and have a bigger impact on improving care. In its new report, NQF calls for the development of a comprehensive database of measures that are in use and under development to improve awareness of measures and any variants among measures being used or developed. Dr. Helen Burstin, NQF's chief scientific officer, explains: "To make care better for patients, in addition to reducing variation in measures, it's also important that we eliminate measures that are duplicative, ineffective or that have reached the limits of their usefulness." NQF's Variation in Measure Specifications project — which was funded by the U.S. Department of Health and Human Services — convened a 16-member multistakeholder panel of experts in measure development and implementation, health informaticists, provider groups, purchasers, payers and others. Panel members aimed to understand how, why and where the tweaking of measures is occurring; promote a common understanding of key terms, concepts and measure components; and create a structure for understanding and interpreting variation across measures. The expert panel came up with a decision-logic framework to reduce measure variation, emphasizing how best to improve the comparability and interpretability of measures, while also furthering transparency and innovation and reducing burden.
Reduced Emergency Department Utilization by Patients with Epilepsy Using QI Methodology
Pediatrics (02/01/17) Vol. 139, No. 2, Patel, Anup D.; Wood, Eric G.; Cohen, Daniel M.
Researchers from Nationwide Children's Hospital and Ohio State University used quality improvement (QI) methodology in an effort to reduce seizure-related emergency department (ED) visits for children with epilepsy. Specifically, the goal was to decrease the number of seizure-related ED visits by 20 percent, from 17 per month per 1,000 patients at baseline to 13.6. Using the Institute for Healthcare Improvement model, the researchers developed a QI project based on a defined outcome to reduce ED utilization for epileptic children. They measured the rate of ED visits as well as unplanned hospitalizations for epilepsy patients and related healthcare costs. Nineteen months after implementation of the QI program, ED visits for this patient population had dropped by 28 percent, to 12.2 ED visits per month per 1,000 patients in the past year. In addition, the average number of inpatient hospitalizations per month decreased by 43 percent, while healthcare claims paid dropped by $115,200 for ED visits and $1.95 million for hospitalizations. According to the authors, using QI methodology was a "highly effective" way to lower ED utilization and unplanned hospitalizations for children with epilepsy.
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