Quality Today
Primaris produces QualityTODAY, the premier source of healthcare quality improvement news in Missouri. QualityTODAY is published quarterly, sent to over 5,000 healthcare professionals and leaders statewide. E-mail Matt Heger (mheger@primaris.org) to get your copy or for reprint information.
Back Issues
WINTER 2007 |
|
Show-Me State Nursing Homes Unite
Advancing Excellence campaign creates strong coalition to further improve nursing home care
Today there are over 39,000 residents living or recuperating in Missouri’s 500 plus nursing homes. With an aging population and the first batch of Baby Boomers turning 60, those numbers are set to climb. Against this backdrop, nursing homes are working against the clock to stand out, provide the best care possible and continuously improve the quality of life within their facilities.
At a time when nursing homes are gaining momentum towards greater quality, a national campaign has arrived to blow some extra wind to their sails. Supporting this campaign is a united coalition of Missouri health care leaders, including Missouri’s nursing home trade associations, state agencies, Primaris and more.
The Advancing Excellence in America’s Nursing Homes campaign began as a discussion between long-term care providers and the Centers for Medicare & Medicaid Services (CMS) in 2005. With support of an expanding group of coalition supporters, Advancing Excellence was launched in September 2006 as a two-year, voluntary campaign. Already, over 1,100 nursing homes have signed on through the campaign Web site, www.nhqualitycampaign.org.
Advancing Excellence is based on an unprecedented, broad-based league of nursing home leaders dedicated to building on the recent advancements in clinical care and culture change in nursing homes across the nation. It is another step in preparing nursing homes for the current and growing emphasis on senior care based on quality measures.
“Quality-based payment strategies are an important component of several CMS programs. Even Missouri’s newly-proposed MO HealthNet, the replacement for Medicaid, includes a pay-for-performance component,” said Denise Clemonds, CEO of the Missouri Association of Homes and Services for the Aging. “The growing links between quality and payment are one reason for nursing homes to participate in the Advancing Excellence campaign.”
Though CMS is a partner in Advancing Excellence, the campaign is an independent effort.
How to Advance Excellence
To become a participant in the Advancing Excellence campaign, nursing homes commit to working on three or more of eight goals. Half of the goals are based on clinical goals, such as reducing pressure ulcers and physical restraint use. The other half are designed to encourage organizational improvements, including staff retention and target setting. At a minimum, participating nursing homes select one goal from each category and a third from either.
“Probably the easiest of the campaign goals is target setting,” said Catherine Gill, Primaris Director of Nursing Home and Home Health Services. “Many Missouri nursing homes already utilize the STAR target-setting Web site – www.nhqi-star.org – immediately checking one task off their Advancing Excellence to-do list.”
 Nursing home leaders have joined together to promote the Advancing Excellence campaign, including (from left) Cindy Wrigley, Executive Director of the Missouri Association of Nursing Home Administrators; Jon Dolan, Executive Director of the Missouri Health Care Association; and Denise Clemonds, CEO of the Missouri Association of Homes and Services for the Aging. (Photo: Matt Heger) |
Progress on clinical measures is derived from publicly reported data on Nursing Home Compare, requiring no additional paperwork or forms on the part of the participating nursing home. For some other measures, data will be submitted by nursing homes to the campaign.
Among other benefits, the campaign is an excellent opportunity to receive support for your quality improvement efforts and join thousands of other nursing homes working on these goals.
“Joining the Advancing Excellence campaign gives your nursing home a chance to showcase improvement efforts publicly, showing how your facility is proactively working to make life better for residents,” said Cindy Wrigley, Executive Director of the Missouri Association of Nursing Home Administrators.
Missouri Partnership
To be successful, campaigns of national magnitude require local hubs for support. In order to provide a high level of assistance in Missouri, nursing home leaders have formed the Missouri Local Area Network for Excellence, or MO LANE. The group encourages local participation and will assist nursing homes statewide with the project. They offer leadership, expertise and resources to participants as well as providing a node for the Advancing Excellence campaign in Missouri.
“MO LANE is a coalition of stakeholders at the local level to drive and coordinate nursing home improvement in Missouri. Our association is proud to do it’s part to provide resources and time to the advancement of this important collaboration,” said Jon Dolan, Executive Director of the Missouri Health Care Association (MHCA). Members of MO LANE include Missouri’s three nursing home trade associations, the
Missouri State Long-Term-Care Ombudsman, Primaris and the Missouri Department of Health and Senior Services. Other organizations can join MO LANE through www.nhqualitycampaign.org.
“Our 315 MHCA member facilities and all in the long-term-care professions can rely on MO LANE for resources, tools and campaign information,” Dolan said.
After signing up online for Advancing Excellence, participating nursing homes can expect to receive a welcome packet from MO LANE including basic information about the program, quality improvement resources, Advancing Excellence campaign window decals and an order form for free Advancing Excellence campaign buttons.
MO LANE is currently planning educational events and developing materials to support those joining the campaign in Missouri.
The first step for nursing homes is to sign up. To register, or for more information, visit www.nhqualitycampaign.org.
Roll up your sleeves and
|
Safer Surgery: CMS Requires New Hospital Publicly Reported Measures
Each year, 30 million major operations are performed in the United States. Each of these millions of operations bring with them inherent risks. Surgical site infection, cardiovascular complications, postoperative pneumonia all are common complications, dramatically increasing costs, hospital stays and mortality.
To address this, Medicare initiated the Surgical Care Improvement Program (SCIP), a national partnership seeking to decrease preventable surgical morbidity and mortality by 25 percent before 2010. SCIP was designed to promote surgical best practices – proper hair removal, timely antibiotic administration, glucose control and temperature monitoring for colorectal surgery patients – some of which are already publicly reported on Medicare’s Hospital Compare (www.hospitalcompare.hhs.gov).
The program is generating progress, and its goals have been adopted by the Institute for Healthcare Improvement’s new Five Million Lives Campaign. However, while most SCIP measures are fairly familiar to hospitals, one is quite new: venous thromboembolism (VTE) prevention.
And since January 1, 2007, measures of VTE prevention must be publicly reported for hospitals to receive Medicare’s full two percent annual payment update.
A patient with VTE has a rogue blood clot blocking a vein which can break off and lodge in the lungs. VTE, specifically pulmonary emboli, are the third most common cause of hospital-related death in the United States. About half of the time, patients with VTE show no symptoms.
VTE is primarily a disease of the hospitalized, with increased risk to critical care, major trauma and spinal cord injury patients. The patient safety advocate organization Leapfrog Group has called VTE “the most common preventable cause of hospital death in the United States,” while the Agency for Healthcare Research and Quality (AHRQ) calls clot treatment the number one patient safety practice.
But despite the well-known risk and publication of evidence-based guidelines for prevention, medical record audits reveal an underuse of prophylaxis. To make matters worse, most hospitalized patients have one or more risk factor for VTE which, among other factors, include previous surgery or increased age.
This year, in order to further encourage hospitals to improve the quality of the health care provided, two SCIP VTE measures will be posted to the Hospital Compare Web site. The measures are:
- Proportion of patients who have recommended VTE prophylaxis ordered
- Proportion of patients who receive an appropriate form of VTE prophylaxis.
The guidelines for appropriate prophylaxis can be found in the American College of Chest Physicians Consensus Recommendations. Implementation will help stymie one of the most common avoidable deaths.
For more information, as well as tools and resources from the SCIP program, visit the Hospital section of www.medqic.org or the Primaris Tools Web site.
Micro Practices: the Lean, Mean Physician Machine
Challenge Your Peers
It’s that time again; time to apply for the 2006 Be a contender. Further information and |
What do you get if you mix low overhead with high technology and wrap it in a patient-centered approach? You get a micro practice, the latest physician office concept designed as an alternative to large, staff-heavy, patient-churning practices.
Micro practices are designed to reduce physician loads, enhance doctor/patient relationships, increase face-to-face time, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system.
Sounds nice, but does it work? Health leaders give it a resounding yes! Last year Dartmouth Medical School faculty carried out a project that helped craft 30 micropractices across the nation. This year the project rolls into Missouri.
In collaboration with Primaris and the St. Louis Area Business Health Coalition, the project is called Ideal Missouri Practice Initiative (IMP) and is funded by the Commonwealth Fund. The goal is to spend 18 months creating Missouri micro practices. To help practices go micro, patient-centered care will be highlighted, overhead will be slashed and technological solutions will be provided.
Low overhead and high technology may strike some as a contradiction, but the Ideal Missouri Practice Initiative shows the two are not mutually exclusive. Staff, consultants, software and IT are not necessary. The project provides the faculty, curriculum and resources practices need. Tools are Web-based and are not dependent on an electronic medical records system.
The program is now accepting a limited number of applicants. It’s grant-funded, so practices participate at no cost. Work is conducted by conference call, listserv and sequenced innovation in practice.
For more information on the Ideal Missouri Practice initiative and micro practices, go to www.idealmissouripractice.org.
Medicare Part D: Medication Therapy Management
Some day soon your patients enrolled in Medicare Part D might be asked by their drug plan if they would like to participate in a free program that allows a health professional to provide a patient-specific review of the medications they take. A phone call to seniors about a free program? Some may be skeptical but, rest assured, this is legitimate.
A little known section of Medicare’s prescription drug benefit requires Part D plans to offer Medication Therapy Management services to a sampling of their consumers, but which consumers and how the service works is left largely up to the individual plans. Here’s how it works.
What is Medication Therapy Management (MTM)?
MTM is a provision of the Medicare Part D prescription drug program that offers services designed to improve medication use and reduce adverse drug events. MTM services should improve the Medicare beneficiary’s knowledge and understanding of their medications, and may include comprehensive medication reviews along with patientspecific medication and disease education. The services can help each person more appropriately use their medications.
Who will be asked to participate?
Eligibility requirements will likely vary greatly from plan to plan, as each drafts their own guidelines for eligibility. However, Medicare requires that plans target individuals who have multiple chronic diseases, have multiple medications covered by Part D and are likely to spend at least $4,000 annually for all prescription drugs covered by Part D. Plans will determine the exact number of medications and the number and types of chronic diseases required to qualify an individual for their MTM services.
How will the services be provided?
Again, each Medicare prescription drug plan selects their own MTM delivery method. MTM programs will primarily use three means of communication with beneficiaries. Eligible individuals may receive written educational materials in the mail, a phone consultation, face-to-face consultation with an approved MTM provider, or a combination of these.
Who will provide MTM services?
Drug plans can use any licensed health care professional including, but not limited to, pharmacists, nurses and physicians as the provider of MTM services. Many plans will use internal staff at a central location to provide the services by phone or mail. Some plans will be contracting with community pharmacists to provide face-to-face MTM. A few will provide feedback directly to the physician for action.
How can I help beneficiaries take advantage of their MTM benefit?
Understand the MTM benefit under Part D and encourage your patients to participate if they are notified by their drug plan that they are eligible. Reassure them that MTM is provided at no additional cost. Reassure them that medication changes can only be made with a physician’s order.
Need more information? Contact Catherine Gill at cgill@primaris.org.