CMS Quality Improvement Activities · hospital care can compare hospitals using this information....
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1 CMS Quality Improvement Activities Future of Healthcare in the Insular Areas A Leaders’ Summit September 29 – 30, 2008 CMS Quality Improvement Activities Future of Healthcare in the Insular Areas A Leaders’ Summit September 29 – 30, 2008 Mary Rydell CMS Region IX Pacific Area Representative San Francisco, Honolulu
Transcript of CMS Quality Improvement Activities · hospital care can compare hospitals using this information....
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CMS Quality Improvement ActivitiesFuture of Healthcare in the Insular Areas
A Leaders’ SummitSeptember 29 – 30, 2008
CMS Quality Improvement ActivitiesFuture of Healthcare in the Insular Areas
A Leaders’ SummitSeptember 29 – 30, 2008
Mary RydellCMS Region IX Pacific Area Representative
San Francisco, Honolulu
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TopicsTopics
HHS Value Driven Health CareMedicare Hospital CompareQuality Improvement OrganizationsState Survey Agency Survey & Certification ActivitiesStay Informed
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Centers for Medicare & Medicaid Services (CMS)
Centers for Medicare & Medicaid Services (CMS)
Administer the Medicare, Medicaid & State Childrens Health Insurance programsRepresent about 33% of the health insurance marketCMS programs - 19.5% of the Federal budget spending; $517.3B in 2006Monitor the health and safety of the providers that serve Medicare and Medicaid beneficiaries
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Four Cornerstones to Value Driven Health Care
Four Cornerstones to Value Driven Health Care
I. Interoperable Health Information Technology(Health IT Standards)
II. Measure and Publish Quality Information(Quality Standards)
III. Measure and Publish Price Information(Price Standards)
IV. Promote Quality and Efficiency of Care(Incentives)
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Why Value Based Purchasing?Why Value Based Purchasing?
Medicare Solvency and Beneficiary ImpactExpenditures up from $219 billion in 2000 to a projected $486 billion in 2009Part A Trust Fund
Excess of expenditures over tax income in 2007Projected to be depleted by 2019
Part B Trust FundExpenditures increasing 11% per year over the last 6 years
Medicare premiums, deductibles, and cost-sharing are projected to consume 28% of the average beneficiaries’ Social Security check in 2010
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Workers per Medicare BeneficiarySelected Years
0
50
100
150
200
1966 2008 2028
in m
illio
ns CoveredWorkers
Part Aenrollment
Source: OACT CMS and SSA
2.493.394.46Worker to Beneficiary Ratio
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0%
3%
6%
9%
12%
1966 1976 1986 1996 2006 2016 2026 2036 2046 2056 2066 2076
Calendar year
Historical Estimated
Payroll taxesTax on benefits
Premiums
General revenue transfers
Total expenditures HI deficit
State transfers
Under Current Law, Medicare Will Place AnUnprecedented Strain on the Federal Budget
Source: 2008 Trustees Report
Per
cent
age
of G
DP
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Medicare Hospital CompareMedicare Hospital Compare
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Hospital CompareHospital Compare
CMS is posting volume and cost information which is a part of the Four Cornerstones- to measure and publish quality and price information. The information on Hospital Compare provides a general overview of hospitals’ performance and Medicare payment. Anyone considering where to get hospital care can compare hospitals using this information.According to the American Hospital Association’s 2006 annual survey, there are 5,747 hospitals in the U.S. As of August 2008, information on 4,486 hospitals could be viewed on Hospital Compare based on both HCAHPS and clinical measure data.
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www.hospitalcompare.hhs.govwww.hospitalcompare.hhs.gov
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www.hospitalcompare.hhs.gov
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Sample Graph 1: Percent of Surgery Patients Who Received Preventative Antibiotic(s) One Hour Before Incision
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Sample Graph 2: Percent of Heart Attack Patients Given Beta Blocker at Arrival
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Sample Graph 3: Percent of Heart Failure Patients Given Discharge Instructions
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Sample Graph 4: Pneumonia 30-Day Mortality
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Quality Improvement OrganizationsQuality Improvement Organizations
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Mountain Pacific Quality Health Foundation here in HonoluluQIO is a group of practicing doctors and other health care professionals paid by CMS to monitor the quality of careInvolvement in QI activities, quality measure reporting with hospitals, NFs, HHAs and physiciansHandle Medicare beneficiary quality of care complaintsExample @ LBJ Tropical Medical CenterExample @ 2 HHAs in Saipan, CNMI
Quality Improvement Organization (QIO)
Quality Improvement Organization (QIO)
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Western Pacific Renal Network in CAContracted with CMS to improve the quality and safety of dialysis related services provided for individuals with ESRD Improve the independence, quality of life, and rehabilitation of individuals through transplantation, use of self-care modalities (e.g., PD, home hemodialysis), and in-center self-care Handle patient's complaints and grievances. Collaboration with providers to ensure achievement of the goalsImprove the collection, reliability, timeliness, and use of data to measure processes of care and outcomes; maintain Patient Registry
ESRD Network 17ESRD Network 17
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State Survey AgencySurvey & Certification Activities
State Survey AgencySurvey & Certification Activities
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Hawaii Department of Health, Office of Healthcare AssuranceNon-accredited hospitals are surveyed every 3 yearsReviewed to ensure the facilities meet Medicare conditions of participation (COP). Different provider types have different time frames and COPs/standardsSurvey data used in Medicare.gov Nursing Home Compare and other comparison toolsTechnical assistance to providers provided through plan of corrections, re-survey process and Federal comparative surveys
State Survey AgencySurvey & Certification Activities
State Survey AgencySurvey & Certification Activities
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CMS http://www.cms.hhs.govPeople with Medicare and public http://www.medicare.govHospital Compare http://www.hospitalcompare.hha.govState Survey Agency http://hawaii.gov/health/elder-care/health-assurance/medicare-facilities/index.htmlMountain Pacific Quality Health Foundation QIO http://www.mpqhf.orgESRD Network 17 http://www.esrdnet17.org
Stay Informed-Resources
Stay Informed-Resources
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Every 3rd Thursday of the month, 2-3pm PSTNext call October 16, 2008 at 2 pm PST.Toll Free: 888-452-0273Pass Code: Stakeholder CallLeader: David SaÿenRegister for “CMS Region IX Stakeholder”ListServ for notification and details about calls, please contact: [email protected]
Stay Informed-Region IX Stakeholder Call
Stay Informed-Region IX Stakeholder Call
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Mahalo!Mahalo!
Mary RydellCMS Region IX Pacific Area Representative
Centers for Medicare & Medicaid ServicesBox 50081
Honolulu, HI [email protected]
(808) 541-2732
