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Ok, so a follower sent me an article from the New York Times that I feel compelled to share. CMS (the folks that run Medicare) have gotten some data regarding CT scans of the chest done in 2008. The radiology experts feel that there is little to no reason to do a CT scan of the chest at the same institution twice in one day and to bill for both studies. They are now using the power of shame to improve patient care. The list has been made available to the general public (and the NYT has put it in a neat interactive graphics package found here) to allow you to look up your hospital and see how they are doing. Remember, there may be a perfectly good explanation but, on the other hand, better to seek out quality at every opportunity.

The Center for Medicare and Medicaid Services is the government agency charged with paying for the healthcare of the 45% of Americans who have either Medicare (over 65) or Medicaid (poor or disabled). Its leader, Don Berwick, has begun the process of making it a much more responsive agency. Just out is a report (full report found here) on the future direction of the agency. Worth a read if you wish to plan for the future instead of live in the past.

CMS has identified 3 National Aims

The National Quality Strategy will pursue three broad aims. These aims will be used to guide and assess local, State, and national efforts to improve the quality of health care.

  • Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
  • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
  • Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.
has six priorities
  • Making care safer by reducing harm caused in the delivery of care.
  • Ensuring that each person and family are engaged as partners in their care.
  • Promoting effective communication and coordination of care.
  • Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
  • Working with communities to promote wide use of best practices to enable healthy living.
  • Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

and has identified 10 areas of policy change going forward to accomplish these priorities

1) Payment reform
” New payment incentives and delivery models that will be launched under the auspices of the Medicare, Medicaid, and private sector partnerships will provide the opportunity to evaluate and bring successful models to scale.”
2) Public Reporting
“. This reporting should be further refined and expanded with broader use of commonly endorsed measures of performance. The new consumer focused web site, will also improve transparency. The site allows all consumers to view the insurance plans in their area, compare them by price and benefits and pick the one that is best for them and their families. There will also be hospital pricing information, in addition to performance data, available online to help inform consumer decisions about where to obtain care.”
3) Quality Improvement/Technical Assistance
“HHS is contracting with QIOs to drive quality improvement through collaboratives at the State level. Collaborative efforts at the local level are also a vital resource for measuring, monitoring, and improving quality of care.”
4) Certification. Accreditation, and Regulation
“Through their regulatory authority, State and Federal agencies overseeing provider organizations and facilities should continue to monitor providers, ensure feedback and accountability, and strengthen patient safety and quality improvement. For example, provider participation in public programs will be conditioned on more rigorous screening to ensure providers meet appropriate standards.”
5) Consumer Incentives and benefits Design
‘Consumer incentives, such as financial assistance for tobacco cessation programs, can help turn good intentions into action. Some employers and private health plans already use the evidence-based programs to promote better health. Similar approaches can improve adherence to recommended medications, which many Americans fail to take, often due to cost. At the Federal level, HHS is promoting value-based insurance models”
6) Measurement of Care Processes and Outcomes
“HHS will promote effective measurement while minimizing the burden of data collection by aligning measures across its programs, coordinating measurement with the private sector and developing a plan to integrate reporting on quality measures with the reporting requirements for meaningful use of electronic health records.”
7) Health Information Technology
“The Office of the National Coordinator for Health Information Technology is focusing its efforts on engaging the private sector, including vendors, service companies, and insurers, to make health information exchange a reality. It is also working with health care providers through Beacon Community Programs, State Health Information Exchange Programs, and Regional Extension Centers to help expand the use of EHRs. At the same time, it builds on State and local efforts to promote better use of health information technology by engaging clinicians, employers, consumers, and others.”
8) Evaluation and feedback
“Clinicians and other providers need timely and actionable feedback in order to improve. Similarly, new innovations in delivery and payment need robust and rapid evaluation to support potential widespread implementation.”
9) Training, Professional Certification, and Workforce Capacity Development
“To achieve the aims and goals of the National Quality Strategy, health care professionals should be encouraged to maximize their training and skills through life-long learning that includes the application of quality improvement principles and patient safety systems concepts such as teamwork. At the same time, there is a need for a new generation of health care professionals.”
10) Promoting Innovation and Rapid Cycle Learning
“. The Innovation Center is supporting new models of care and innovative practices for Medicare, Medicaid, and CHIP beneficiaries, with the goal, for example, of improving transitions from various health settings within a patient’s community.”