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CMS May Add New Measures to Hospital Reporting Requirements
The Centers for Medicare and Medicaid Services (CMS) last month recommended updates to the hospital payment policies and rates, starting in fiscal year 2009.

Some of the proposed changes are related to the agency's efforts to make hospitals bear increased costs of treatment when patients acquire conditions that are preventable through adherence to evidence-based guidelines. Other changes would increase the number of quality measures that hospitals are required to report to CMS in order to receive a full payment update the following year. These new measures would include patient safety indicators and inpatient quality indicators developed by the federal Agency for Healthcare Research and Quality (AHRQ).

Some of the quality measures would not involve hospitals reporting data to CMS; instead, CMS would calculate performance based on administrative data. In all, CMS has proposed to add 43 new measures and to retire an existing measure. If the proposals are adopted, the total number of reporting measures for FY 2010 would reach 72.

Medicare Launches Personal Health Records Pilot
Would elderly and disabled Medicare beneficiaries make use of Web-based personal health records (PHRs) if they had access to them? CMS is seeking to answer this question through a one-year pilot program launched this month in South Carolina.

Thousands of Medicare beneficiaries have been given access to PHRs, which contain information about their hospital and outpatient care, as well as links to information about their health conditions. Beneficiaries can manually enter information on their prescriptions and over-the-counter medications. They also can choose to share these records with family members or providers by designating them as their authorized representatives.

Through the pilot, CMS hopes to learn more about beneficiaries' use of PHRs and ways to encourage further use. While participation is voluntary, CMS will be promoting the program to beneficiaries and physicians as part of the pilot.

Life Expectancy Declining in Parts of U.S.
Last month, the New York Times reported the results of a study showing that, while overall average life expectancy increased for American men and women between 1960 and 2000, it decreased or held steady for men and women in poor and rural parts of the country.

This study of long-term mortality trends, published in PLoS Medicine and based on data from the National Center for Health Statistics and U.S. Census Bureau, found that the average U.S. life expectancy increased by seven years for men and by six years for women over this time period.

Yet, beginning in the 1980s, 4 percent of males and 19 percent of females experienced a decline or stagnation in life expectancy. The most significant declines were seen in Appalachia, the Southeast, Texas, the southern Midwest, and along the Mississippi River. The study pinpointed disparities in mortality rates by focusing on counties, the smallest unit for which mortality data are available.

Researchers determined that the leveling off or drops in life expectancy were rooted in the rising rates of diabetes, cancer, and chronic obstructive pulmonary disease, as well as a lack of improvement in cardiovascular mortality. They note that these conditions are closely related to smoking, high blood pressure, and obesity, all of which are amenable to changes in personal lifestyle and public health initiatives.

Nine States to Take Part in Quality Improvement Institute
Nine states will work to develop comprehensive quality improvement strategies in a new State Quality Improvement Institute led by The Commonwealth Fund and AcademyHealth. The states have each identified particular areas of focus, including value-based purchasing, quality reporting, care coordination, disease prevention, and wellness promotion. The Institutes' leaders will help states evaluate their policy options, provide expert and technical advice for planning and implementation, and facilitate networking among the states. The participating states are Colorado, Kansas, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Vermont, and Washington.

The Institute was created in response to Commonwealth Fund research documenting considerable variations in health care quality by geographic region. The Fund's State Scorecard suggests that states could save thousands of lives and significantly reduce costs if they raised performance to the levels achieved in top-performing states.

AHRQ Creates Innovation Clearing House
AHRQ recently launched the Health Care Innovations Exchange, a Web site designed to disseminate best practices in health care delivery. Users can search through summaries of health care innovations in various areas of medical practice, take part in learning networks, and access educational resources.

Featured initiatives include: a standardized process to ensure smooth and safe transitions during nursing shift changes; a program to treat children with chronic illness who are not sick enough to be hospitalized, but whose outpatient treatment has not been effective; and a school-based program that delivers oral health education and treatment to low-income children. The site includes examples of efforts with demonstrated success, as well as some that did not succeed due to problems with implementation, sustainability, or unforeseen negative consequences. In addition to summaries of innovative programs, the site includes quality tools such as worksheets, questionnaires, benchmarks, software, planning resources, calculators, algorithms, checklists, and brochures.

An AHRQ editorial team chooses the innovations and tools to feature on the site, selecting those that they deem to be new, have significant potential to change patient care delivery, and are designed to address health disparities.

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