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Health Care Performance

Chronically Ill Receiving Unnecessary Care
Eliminating variability in the care of chronically ill elderly patients could improve their health outcomes and prolong the solvency of the Medicare program, according to a new study by the Center for the Evaluative Clinical Sciences at Dartmouth Medical School. Funded by the Robert Wood Johnson Foundation, The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program by the Dartmouth Atlas Project found that almost one-third of Medicare spending on chronically ill patients is unnecessary. The report recommends redirecting resources away from acute care and investing in an infrastructure, including home health and hospice care, that can better coordinate and integrate care outside of hospitals. It also calls for a reimbursement system that rewards provider organizations for reducing services and developing broader strategies for managing patients with chronic illness.

Medi-Cal Managed Care: Rewarding Performance
The California Department of Health Services last year implemented a performance-based incentive system to reward contractors for providing higher-quality care to Medicaid beneficiaries. Based on five quality measures and two safety net participation measures, the program rewards higher-performing Medi-Cal contractors with more enrollees. A report released by the California HealthCare Foundation this month, Putting Quality to Work: Rewarding Plan Performance in Medi-Cal Managed Care, provides an overview of the process the state took to develop this incentive and its impact to date.

OPM Requires Quality Reporting
The Office of Personnel Management (OPM), the federal government's human resources agency, will require fee-for-service health plans with which it holds contracts to collect and report quality performance measures comparable to those currently required of health maintenance organizations, beginning in 2007. Based on the National Committee for Quality Assurance's experience with the feasibility of collecting measures through administrative data systems, Federal Employees Health Benefits fee-for-service plans will collect data on five Health Plan Employer Data Information Set (HEDIS) measures. They include: breast cancer screening, cholesterol management for patients with cardiovascular conditions (LDL-C screening), and comprehensive diabetes care testing (Hemoglobin A1c testing, retinal eye exam, and LDL-C screening). The OPM's goal is to provide federal employees with better comparative information to make educated choices among health plans.

Massachusetts Blues Expand P4P
Blue Cross Blue Shield of Massachusetts is doubling the amount it spends on performance incentives for health care providers to $189 million this year, according to an article in The Boston Globe. The company, which is drawing some criticism from doctors, hospitals, and competing health plans, is shifting to contracts that make some portion of payments contingent on quality and efficiency. It also is developing ways to grade 9,100 cardiologists, oncologists, and other specialists on the quality of their care.

Patient Safety

Innovative Hospital Designs Reduce Errors
A growing number of hospital administrators have begun factoring their facility's layout and design into the patient-safety equation, according to a May 8 article in The Wall Street Journal. St. Joseph's Hospital in West Bend, Wis., had architects focus on health and safety considerations—slip-proof floors, soundproof walls, identical rooms, healthier airflow, and nurse station placement—when drawing up blueprints for a new hospital building. The facility has demonstrated increased safety through lower infection rates, fewer injuries from falls, fewer medication errors, and decreased average length of stay since opening last summer. Likewise, the University of Michigan Health System's new children and women's hospital in Ann Arbor is being built with safety features that include interior corners with rounded edges and an air circulation system that doesn't recycle air, which can spread infectious germs.

HealthGrades Study: American Hospital Patient Safety
About 1.24 million patient safety incidents occurred among the Medicare program's nearly 40 million hospitalizations between 2002 and 2004, according to a report released by a Colorado-based health care ratings company last month. This represents an increase from 1.18 million patient safety incidents over the previous three-year period, as well as excess costs of $9.3 billion and 304,702 deaths—250,246 of which were potentially preventable. The HealthGrades study also identified wide gaps in patient safety incidence levels between the top-performing states and those at the bottom, translating into a 30 percent overall lower risk for Medicare patients in Minnesota compared with those in New Jersey. Incidents that occurred at the highest rates include failure to rescue, decubitus ulcer, and post-operative sepsis. The HealthGrades study applied the Agency for Healthcare Research and Quality Patient Safety Indicator methodology to three years of Medicare data.

Using IT to Reduce Hospital Infections
The Intermountain Center of Excellence for Infection Prevention Strategies (INTERCEPT) this month received a grant from the U.S. Centers for Disease Control and Prevention to develop and test innovative approaches to reduce infections in health care settings. One of five national sites funded through the program, INTERCEPT (a collaboration between the University of Utah, University Health Care, Intermountain Healthcare, and the VA Salt Lake City Health Care System) will receive $2 million over the next five years. Researchers will work to improve methods to detect health care–associated infections and implement strategies to prevent them, using computerized medical records and alerting systems. They also will evaluate mechanisms to reduce the transmission of antibiotic-resistant bacteria, find ways to decrease the prolonged use of urinary catheters—which can lead to urinary tract infections—and devise computer-based surveillance to track problems associated with electronic medical devices.


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