Going After Health Care's "Super-Utilizers"
In the January 24 issue of he New Yorker, writer and surgeon Atul Gawande, M.D., describes an effort in Camden, N.J., to lower health care costs by targeting patients who are heavy users of medical services: in Camden, 1 percent of patients are responsible for 30 percent of medical costs. The effort, modeled on a law enforcement approach that targets crime clusters, uses a health care team, including a nurse practitioner and social worker, to work with "super-utilizers" of health care—those patients who cycle in and of hospitals and emergency departments and often struggle with drug or alcohol problems, obesity, housing issues, or other challenges. The program produced a 40 percent reduction in average monthly hospital and emergency department use among its first 36 patients.
VA Launches Hospital Compare Site; CMS Launches Physician Compare
In late 2010, the U.S. Department of Veterans Affairs (VA) launched its own version of Hospital Compare, the Centers for Medicare and Medicaid Services' site that reports on the performance of private sector hospitals. On VA Hospital Compare, users can compare the performance of 153 VA hospitals on the following: outcome measures for acute care, patient safety, intensive care, and other areas; outcome and process measures for heart failure, heart attack, and pneumonia; and measures of surgical care processes aimed at reducing complications. The site also includes the "Aspire" dashboard, which documents VA hospitals' performance on a wide variety of quality and safety measures relative to the VA's goals and national benchmarks.
On Dec. 30, 2010, the federal government launched Physician Compare, as required by the Affordable Care Act. For now, the public reporting site is mainly an updated directory of physicians and other health care providers who accept Medicare patients. Those who participate in Medicare's Physician Quality Reporting System are noted, and later this year providers who participate in Medicare's electronic prescribing initiative will be highlighted. By 2013, the site is expected to include performance information on individual providers, including data on whether they make "meaningful use" of health information technology.
NCQA Releases New Medical Home Standards
In late January, the National Committee for Quality Assurance published new standards for primary care practices seeking to be recognized as patient-centered medical homes. Thus far, 7,700 health care providers at 1,500 practices have earned recognition as a patient-centered medical home. The 2011 standards require practices to: assist patients with self-care; help patients access community resources; improve communication between medical facilities; and provide more patient-centered services. Also for the first time, applicants will be evaluated on whether their practices make "meaningful use" of health information technology, as defined by the federal government's incentive program for Medicare and Medicaid.
New Patient Safety Group Formed
This month, the Boston-based National Patient Safety Foundation launched the nation's first individual membership program for professionals working in the patient safety field. According to the Feb. 15 announcement, the American Society of Professionals in Patient Safety was established "to build an engaged, focused community of individuals committed to accelerating the delivery of safe patient care." There are currently 175 members; the society hopes to attract others across disciplines, including those who are primarily responsible for patient safety, as well as medical leaders, medical students, providers, risk management and quality leaders, and patient safety advocates. The society will establish a certification program to promote competencies in patient safety.