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Hospital Safety Efforts Linked to Patient Satisfaction
According to a new study, patients are aware of and value hospitals' efforts to improve the quality and safety of their care. The study, released in December by Press Ganey and The Leapfrog Group, two organizations that monitor hospital performance, found patients treated at hospitals that report their safety practices to The Leapfrog Group's Hospital Quality and Safety Survey are more satisfied than those at hospitals that do not volunteer this information. The survey collects data from hospitals on their progress in implementing four safe practices endorsed by the National Quality Forum.

By the same token, hospitals that measure patient satisfaction with Press Ganey score better on Leapfrog's measures of quality and safety than hospitals that are not clients of Press Ganey.

Patient satisfaction is gaining ground as a valid measure of health care quality, according to experts at a December forum hosted by the Alliance for Health Reform and The Commonwealth Fund. Citing a report by the Joint Commission Journal on Quality and Patient Safety linking patient-centered care with a decrease in patient complications and deaths, Fund President Karen Davis suggested that pay-for-performance programs should incorporate measures of patient-centered care.

From 100,000 to 5 Million: IHI's New Patient Safety Campaign
Last month, the Institute for Healthcare Improvement (IHI) announced a national campaign to prevent 5 million incidents of medical harm by Dec. 9, 2008. The 5 Million Lives Campaign aims to enlist 4,000 hospitals, building on the organization's 100,000 lives campaign, in which 3,100 hospitals reduced patient deaths by an estimated 122,000.

Participating hospitals will be asked to adopt at least one of 12 practices intended to save lives and avoid injuries; six of these practices were included in the 100,000 lives campaign and six are new interventions. Hospitals will have access to guidelines and other resources to support their efforts, and will be required to regularly report hospital profile and mortality data to IHI. Principal funding for the campaign comes from America's Blue Cross and Blue Shield health plans.

CMS Posts Data on Costs of Common Procedures
In late November, the Centers for Medicare and Medicaid Services (CMS) posted data on the Health Care Consumer Initiatives Web site about its payment rates for common services provided in physician offices and hospital outpatient departments. CMS had posted data on the payment rates for treatments delivered in inpatient hospital departments and ambulatory surgery centers earlier last year. These efforts respond to President Bush's Executive Order calling on HHS to make cost and quality data available to all Americans.

CMS' site now includes information on 72 physician services typically delivered outside of physician offices and 19 services performed in offices; costs for these procedures may vary depending on the delivery location and/or region of country. The site also includes possible scenarios to show consumers how they can use the payment rate data, together with information on the quality of care available on the Hospital Compare Web site, to choose the best quality and highest-value choice for a colonoscopy or cataract surgery.

Medicare plans to make information on patient satisfaction available to consumers later this year.

Productivity Incentives Overshadow Quality-Based Pay
The proportion of physicians in group practice whose compensation is based partially on quality measures increased from 17.6 percent in 2000–2001 to 20.2 percent in 2004–2005. Yet, far more physicians in group practice have financial incentives tied to individual productivity, according to a national study by the Center for Studying Health System Change.

The study found that size matters: physicians in larger group practices, as well as hospital, medical school, or other institutional practices, are more likely to be compensated in part on the basis of quality than physicians in smaller group practices.

Nearly three of four physicians with productivity-based financial incentives—or more than half of all physicians—viewed these incentives as a very important factor in determining their compensation. By comparison, 44 percent of physicians offered quality-related incentives viewed such incentives as very important to their compensation, which represents just 9 percent of physicians overall.

Companies Develop Personal Health Records
Two recent initiatives gave a boost to the development of portable and lifelong health records controlled by individual patients, called personal health records (PHRs).

Five major U.S. companies, Intel, Wal-Mart, Pitney-Bowles, British Petroleum-America Inc., and Applied Materials, announced in December that they will offer health records to a combined 2.5 million employees, retirees, and their families by mid-2007. Individuals will control their own health records, sharing information with providers and other parties as they choose. The shared health record technology, called Dossia, will be developed and hosted by Omnimedix Institute, a Portland, Ore. –based nonprofit organization.

Also in December, America's Health Insurance Plans and Blue Cross and Blue Shield Association announced that the two trade associations were collaborating to create a Web-based PHR by 2008. The model PHR will include medical histories, medications, immunizations, allergies, risks, and care plans and will be maintained by insurers but portable across different plans.

U.S. Companies to Offer Free E-Prescribing
On Jan. 16, some of the nation's largest companies—including the health insurers Aetna and Wellspring, the technology firms Microsoft, Google, and Dell, as well as health systems and pharmacy groups—announced a partnership to offer every U.S. physician free electronic prescribing. The National ePrescribing Patient Safety Initiative will give doctors access to e-prescribing tools through a Web-based interface. The initiative is intended to reduce the incidence of medication errors, which, according to the Institute of Medicine, sicken an estimated 1.5 Americans each year. E-prescribing has the potential to avoid errors related to handwriting and transcription; the system can also provide automated alerts for drug interactions or Food and Drug Administration warnings.

Doctors' adoption of e-prescribing has been slow, mainly because of the expense of purchasing technology and training staff to use it. A 2003 Commonwealth Fund survey found that only about a quarter (27%) of physicians use electronic ordering of drugs routinely or occasionally.

Sponsors of the initiative may accrue financial benefits. For example, insurers may have fewer claims related to medication errors, while participating pharmacy networks may be able to fill more prescriptions.

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