"Substantial Minority" of People Equate High Healthcare Costs with High Healthcare Quality

The March 2012 issue of Health Affairs published an AHRQ funded study that found consumer selection of healthcare providers may gravitate towards higher cost options when clear quality information is not also presented. This is contrary to the intended outcome of the cost transparency movement in healthcare.

The AHRQ press release can be found here: http://www.ahrq.gov/news/press/pr2012/highvaluepr.htm

The Health Affairs abstract (and article for purchase) can be found here: http://content.healthaffairs.org/content/31/3/560.abstract

A powerpoint presentation summarizing this study's findings can be found here: http://www.ahrq.gov/about/annualconf11/hibbard_mehrotra/hibbard.pptx

The following are excerpts from the AHRQ press release associated with the publication of this study:

When asked to choose a health care provider based only on cost, consumers choose the more expensive option, according to a new study funded by HHS' Agency for Healthcare Research and Quality (AHRQ) that appears in the March issue of Health Affairs.

The study found that consumers equate cost with quality and worry that lower cost means lower quality care. But higher costs may indicate unnecessary services or inefficiencies, so cost information alone does not help consumers get the best value for their health care dollar, according to the study.

The study, entitled "An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-Value Health Care," found that when consumers were shown the right mix of cost and quality information, they were better able to choose high-value health care providers—defined as those who deliver high-quality care at a lower cost.

The study explored a number of ways to present cost and quality information effectively, using combinations of symbols such as dollar signs and stars, specific information such as dollar amounts and percentages, and labels such as "appropriate use" or "better." Consumers were more likely to choose high-value providers when presented with strong, unambiguous quality and cost information. In addition, a check mark indicating a "high-value" provider, along with the cost and quality information, also helped consumers use the information to make high-value choices. Given strong quality signals, consumers were also more confident in their choices.

CMS Proposes Value Based Purchasing Program Rules for Hospital Inpatient

On Friday, CMS announced its highly anticipated proposed rules for its new hospital value based purchasing program. The pdf of the proposed rules can be found here: http://www.ofr.gov/OFRUpload/OFRData/2011-00454_PI.pdf
(Note: this link will not likely become live until 1/13/2011).

Although these are "new" proposed rules, there are really no surprises in terms of payment methodology. The amount "at risk" due to poor performance is probably lower than what was initially expected (ie: 1-2% rather than 4-5%).


The following are excerpts from the CMS press release and fact sheet that may be of interest:

• Under the program, hospitals that perform well on quality measures relating both to clinical process of care and to patient experience of care, or those making improvements in their performance on those measures, would receive higher payments.
• The financial incentives would be funded by a reduction in the base operating DRG payments for each discharge, which under the statute will be 1% in FY 2013, rising to 2% by FY 2017.
• CMS will accept comments on the hospital value-based purchasing Program proposed rule until March 8, 2010, and will respond to them in a final rule to be issued next year.
• For the FY 2013 hospital value-based purchasing program, CMS proposes to use 17 clinical process of care measures as well as 8 measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that document patients’ experience of care.
• CMS also proposes to adopt three mortality outcome measures, eight Hospital Acquired Condition (HAC) measures, and nine Agency for Healthcare Research and Quality (AHRQ) measures for the FY 2014 Hospital VBP program.
• Proposed Performance Period: As required by the Affordable Care Act, CMS is proposing a performance period that ends prior to the beginning of FY 2013, specifically from July 1, 2011 through March 31, 2012, for the FY 2013 hospital value-based purchasing payment determination. CMS anticipates that in future fiscal years, the Agency may propose to use a full year as the performance period. In addition, CMS is proposing to use an 18-month performance period for the three proposed mortality measures for the FY 2014 Hospital VBP payment determination, and expects to propose a performance period for the eight HAC and nine AHRQ measures in future rulemaking.
• Proposed Scoring Methods: CMS proposes to score each hospital on relative achievement and improvement ranges for each applicable measure. A hospital’s performance on each quality measure would be evaluated based on the higher of an achievement score in the performance period or an improvement score, which is determined by comparing the hospital’s score in the performance period with its score during a baseline period of performance. For each of the proposed clinical process and patient experience of care measures that apply to a hospital for FY 2013, CMS proposes that a hospital would earn 0-10 points for achievement based on where its performance for the measure fell within an achievement range, which is a scale between an achievement threshold and a benchmark. With regard to the improvement score, CMS proposes that a hospital would earn 0-9 points based on how much its performance on the measure during the performance period improved from its performance on the measure during the baseline period. Finally, CMS would calculate a Total Performance Score (TPS) for each hospital by combining its scores on all of the measures within each domain, multiplying its performance score on each domain by the proposed weight for the domain, and adding the weighted scores for the domains.
• Proposed Incentive Payment Calculations:  CMS proposes to translate each hospital’s TPS into a value-based incentive payment using a linear exchange function.  The linear exchange function provides the same marginal incentives to both lower- and higher-performing hospitals.
• CMS proposes to notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012.  CMS proposes to notify each hospital of the exact amount of its value-based incentive payment on or about Nov. 1, 2012.
• CMS will accept public comments on the proposed rule through March 8, 2010  CMS will review all comments and respond to them in a final Hospital VBP rule scheduled to be released some time in 2011.

PROPOSED QUALITY MEASURES FY2013   
AMI-2: Aspirin Prescribed at Discharge
AMI-7a: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a: Primary PCI Received Within 90 Minutes of Hospital Arrival
 
HF-1: Discharge Instructions
HF-2: Evaluation of LVS Function
HF-3: ACEI or ARB for LVSD

PN-2: Pneumococcal Vaccination
PN-3b: Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6: Initial Antibiotic Selection for CAP in Immunocompetent Patient
PN-7: Influenza Vaccination 
SCIP-Inf-1: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
SCIP-Inf-2: Prophylactic Antibiotic Selection for Surgical Patients
SCIP-Inf-3: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
SCIP-Inf-4: Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose
SCIP-Card-2: Surgery Pts. on a Beta Blocker Prior to Arrival... 
SCIP-VTE-1: Surgery Pts. with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2: Surgery Pts. Who Received Appropriate Venous Thromboembolism Prophylaxis...
 
HCAHPS: Communication with Nurses
HCAHPS: Communication with Doctors
HCAHPS: Responsiveness of Hospital Staff
HCAHPS: Pain Management
HACHPS: Communication About Medicines
HACHPS: Cleanliness and Quietness of Hospital Environment
HACHPS: Discharge Information
HACHPS: Overall Rating of Hospital

PROPOSED ADDITIONAL QUALITY MEASURES FOR FISCAL YEAR 2014

Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate

Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcer Stages III & IV
Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
Vascular Catheter-Associated Infections
Catheter-Associated Urinary Tract Infection (UTI)
Manifestations of Poor Glycemic Control

PSI 06 – Iatrogenic pneumothorax, adult
PSI 11 – Post Operative Respiratory Failure
PSI 12 – Post Operative PE or DVT
PSI 14 – Post Operative would dehiscence
PSI 15 – Accidental puncture or laceration
IQI 11 – Abdominal aortic aneurysm (AAA) repair mortality rate (with or without volume)
IQI 19 – Hip fracture mortality rate

Complication/patient safety for selected indicators (composite)
Mortality for selected medical conditions (composite)

Eight Recommendations for Policies for Communicating Abnormal Test Results

The Joint Commission recently published this article in its Joint Commission Journal on Quality and Patient Safety (May 2010, Volume 36 No 5).

The article can be downloaded free from AHRQ here: http://psnet.ahrq.gov/public/Singh-JCJQPS-2010_PSNetID18026.pdf

The eight recommendations are:

1. Policies should be introduced with clear definitions of key terms.
2. Policies should clearly outline provider responsibilities.
3. Policies should specify procedures for fail-safe communication of abnormal test results.
4. Policies must define verbal and/or electronic reporting procedures for both critical and significantly abnormal laboratory, imaging, and other test values.
5. Policies should specify "Critical Tests" and acceptable length of time between their ordering and reporting.
6. Policies should define time lines between the availability of test results and patient notification, and institutions should specify preferred mechanisms for patient notification.
7. Policies must be of "real world" value and written with feedback from key stakeholders.
8. Policies should establish responsibilities for monitoring and evaluating communication procedures.

The following is the text of the Article-at-a-Glance:

Background: Health care organizations continue to struggle to ensure that critical findings are communicated and acted on in a timely and appropriate manner. Recent research highlights the risks of communication breakdowns along the entire spectrum of test-result abnormality, including
significantly abnormal but nonemergent findings. Evidence-based and practical institutional policies must uphold effective processes to guide communication of abnormal test results. Eight recommendations for effective policies on communication of abnormal diagnostic test results were developed based on policy refinement at the Michael E. DeBakey Veterans Affairs Medical Center
(Houston), institutional experience with test result management, and findings from research performed locally and elsewhere.

Key Facets of Effective Policies: Research findings on vulnerabilities in existing policies and procedures were taken into consideration. The eight recommendations are based on important refinements to the policy which clarified staff roles and responsibilities for test ordering, follow-up, and communication; defined categories of abnormal test results to guide appropriate follow-up action; and elaborated procedures for monitoring the effectiveness of test result communication
and follow-up. Participation of key stakeholders is recommended to enhance buy-in from personnel and to help ensure the policies feasibility and sustainability.

Conclusions: The proposed recommendations for ensuring safe test-result communication may be potentially useful to a wide variety of institutions and health care settings. These practical suggestions, based on research findings and experiences with a previous policy, may be a useful
guide for designing or amending policies for safe test-result communication in both inpatient and outpatient settings.

AHRQ: 10 Patient Safety Tips for Hospitals

The Agency for Healthcare Research and Quality (AHRQ) recently updated their publication titled "10 Patient Safety Tips for Hospitals".

The 10 Tips are:

1. Prevent central line-associated blood stream infections.
2. Re-engineer hospital discharges.
3. Prevent venous thromboembolism.
4. Educate patients about using blood thinners safely.
5. Limit shift durations for medical residents and other hospital staff if possible.
6. Consider working with a Patient Safety Organization.
7. Use good hospital design principles.
8. Measure your hospital's patient safety culture.
9. Build better teams and rapid response systems.
10. Insert chest tubes safely.

The AHRQ publications contains links to resources supporting each of the above tips. The publication can be found here: http://www.ahrq.gov/qual/10tips.pdf.

The home page of the publication is here: http://www.ahrq.gov/qual/10tips.htm

Indiana HCAHPS Performance - Patient's Overall Rating of Hospital

The following is the most recent list of Indiana hospitals sorted by the percent of patients rating the hospital 9 or 10 on the HCAHPS question about overall care. This is derrived from the hospital compare database which was updated Dec 2009.

Percentage of patients who gave rating of 9 or 10 (high)
% Hospital
91 WOMEN'S HOSPITAL THE(NEWBURGH)
89 ST VINCENT HEART CENTER OF INDIANA LLC(INDIANAPOLIS)
87 INDIANA ORTHOPAEDIC HOSPITAL LLC(INDIANAPOLIS)
83 MONROE HOSPITAL(BLOOMINGTON)
82 INDIANA HEART HOSPITAL, THE(INDIANAPOLIS)
82 CLARIAN NORTH MEDICAL CENTER(CARMEL)
81 ST FRANCIS HOSPITAL MOORESVILLE(MOORESVILLE)
79 DUPONT HOSPITAL LLC(FORT WAYNE)
79 DEKALB MEMORIAL HOSPITAL INC(AUBURN)
78 PARKVIEW HUNTINGTON HOSPITAL(HUNTINGTON)
78 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC(FORT WAYNE)
78 ST VINCENT CARMEL HOSPITAL INC(CARMEL)
77 CLARIAN WEST MEDICAL CENTER(AVON)
77 HENDRICKS REGIONAL HEALTH(DANVILLE)
77 PARKVIEW HOSPITAL(FORT WAYNE)
77 MEMORIAL HOSPITAL AND HEALTH CARE CENTER(JASPER)
76 WITHAM HEALTH SERVICES(LEBANON)
76 TIPTON HOSPITAL(TIPTON)
76 PARKVIEW NOBLE HOSPITAL(KENDALLVILLE)
76 PARKVIEW LAGRANGE HOSPITAL(LAGRANGE)
76 SCHNECK MEDICAL CENTER(SEYMOUR)
75 PARKVIEW WHITLEY HOSPITAL(COLUMBIA CITY)
75 WABASH COUNTY HOSPITAL(WABASH)
75 GOSHEN GENERAL HOSPITAL(GOSHEN)
75 FRANCISCAN PHYSICIANS HOSPITAL LLC(MUNSTER)
75 DUNN MEMORIAL HOSPITAL(BEDFORD)
74 LUTHERAN HOSPITAL OF INDIANA(FORT WAYNE)
74 GOOD SAMARITAN HOSPITAL(VINCENNES)
74 ST VINCENT WILLIAMSPORT HOSPITAL INC(WILLIAMSPORT)
74 MARGARET MARY COMMUNITY HOSPITAL INC(BATESVILLE)
74 RIVERVIEW HOSPITAL(NOBLESVILLE)
74 ST FRANCIS HOSPITAL AND HEALTH CENTERS-INDIANAPOLI(INDIANAPOLIS)
74 CLARK MEMORIAL HOSPITAL(JEFFERSONVILLE)
73 ST MARY MEDICAL CENTER INC(HOBART)
73 MAJOR HOSPITAL(SHELBYVILLE)
73 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC(EVANSVILLE)
73 MEMORIAL HOSPITAL OF SOUTH BEND(SOUTH BEND)
73 SAINT JOHN'S HEALTH SYSTEM(ANDERSON)
72 COMMUNITY HOSPITAL(MUNSTER)
72 ST VINCENT HOSPITAL & HEALTH SERVICES(INDIANAPOLIS)
72 JAY COUNTY HOSPITAL(PORTLAND)
72 BLUFFTON REGIONAL MEDICAL CENTER(BLUFFTON)
71 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY(ANDERSON)
71 COLUMBUS REGIONAL HOSPITAL(COLUMBUS)
71 HARRISON COUNTY HOSPITAL(CORYDON)
71 FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES(NEW ALBANY)
70 BEDFORD REGIONAL MEDICAL CENTER(BEDFORD)
70 HENRY COUNTY MEMORIAL HOSPITAL(NEW CASTLE)
70 ST FRANCIS HOSPITAL AND HEALTH CENTERS(BEECH GROVE)
69 HANCOCK REGIONAL HOSPITAL(GREENFIELD)
69 ST JOSEPH HOSPITAL & HEALTH CENTER INC(KOKOMO)
69 CAMERON MEMORIAL COMMUNITY HOSPITAL INC(ANGOLA)
69 ST VINCENT FRANKFORT HOSPITAL INC(FRANKFORT)
69 ST VINCENT MERCY HOSPITAL(ELWOOD)
69 ST ANTHONY(CROWN POINT)
******69 Indiana State Average******
68 SCOTT COUNTY MEMORIAL HOSPITAL AKA SCOTT MEMORIAL(SCOTTSBURG)
68 SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH(PLYMOUTH)
68 ST CATHERINE HOSPITAL INC(EAST CHICAGO)
68 LAPORTE HOSPITAL AND HEALTH SERVICES(LA PORTE)
68 WESTVIEW HOSPITAL(INDIANAPOLIS)
68 KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES,THE(MADISON)
67 COMMUNITY HOSPITAL SOUTH(INDIANAPOLIS)
67 DECATUR COUNTY MEMORIAL HOSPITAL(GREENSBURG)
67 MARION GENERAL HOSPITAL(MARION)
67 DAVIESS COMMUNITY HOSPITAL(WASHINGTON)
66 SULLIVAN COUNTY COMMUNITY HOSPITAL(SULLIVAN)
66 ST JOSEPH HOSPITAL(FORT WAYNE)
66 REID HOSPITAL & HEALTH CARE SERVICES INC(RICHMOND)
66 DUKES MEMORIAL HOSPITAL(PERU)
66 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND(SOUTH BEND)
66 MEMORIAL HOSPITAL(LOGANSPORT)
66 DEACONESS HOSPITAL INC(EVANSVILLE)
66 JOHNSON MEMORIAL HOSPITAL(FRANKLIN)
******65 National Average******
65 HOWARD REGIONAL HEALTH SYSTEM(KOKOMO)
65 ST VINCENT JENNINGS HOSPITAL INC(NORTH VERNON)
65 GIBSON GENERAL HOSPITAL(PRINCETON)
65 CLARIAN HEALTH PARTNERS INC D/B/A METHODIST IU RIL(INDIANAPOLIS)
65 BALL MEMORIAL HOSPITAL INC(MUNCIE)
65 ST VINCENT CLAY HOSPITAL INC(BRAZIL)
64 ELKHART GENERAL HOSPITAL(ELKHART)
64 BLOOMINGTON HOSPITAL(BLOOMINGTON)
64 ST MARGARET MERCY HEALTHCARE CENTERS(DYER)
64 WILLIAM N WISHARD MEMORIAL HOSPITAL(INDIANAPOLIS)
64 UNION HOSPITAL CLINTON(CLINTON)
63 KOSCIUSKO COMMUNITY HOSPITAL(WARSAW)
63 DEARBORN COUNTY HOSPITAL(LAWRENCEBURG)
63 FAYETTE REGIONAL HEALTH SYSTEM(CONNERSVILLE)
63 PORTER, VALPARAISO HOSPITAL(VALPARAISO)
62 ST ANTHONY MEMORIAL HEALTH CENTERS(MICHIGAN CITY)
62 UNION HOSPITAL, INC(TERRE HAUTE)
61 COMMUNITY HOSPITALS OF INDIANA INC (EAST)(INDIANAPOLIS)
61 ST ELIZABETH CENTRAL(LAFAYETTE)
60 TERRE HAUTE REGIONAL HOSPITAL(TERRE HAUTE)
60 ST CLARE MEDICAL CENTER(CRAWFORDSVILLE)
59 MORGAN HOSPITAL AND MEDICAL CENTER(MARTINSVILLE)
56 ST MARGARET MERCY HEALTHCARE CENTERS(HAMMOND)
56 STARKE MEMORIAL HOSPITAL(KNOX)
55 ST MARY'S WARRICK HOSPITAL INC(BOONVILLE)
55 LAFAYETTE HOME HOSPITAL(LAFAYETTE)
54 ST VINCENT RANDOLPH HOSPITAL INC(WINCHESTER)
44 METHODIST HOSPITALS, INC(GARY)
39 SAINT CATHERINE REGIONAL HOSPITAL(CHARLESTOWN)

Healthy People 2020 - Review Draft Objectives

Early last week the US Dept of Health and Human Services released the draft Healthy People 2020 objectives for public comments via the internet.

Historically, federal agencies have been guided somewhat by the objectives set in Healthy People. Every 10 years, the objectives are developed, reviewed, updated, and/or archived.

You can download the draft objectives here: http://www.healthypeople.gov/hp2020/Objectives/files/Draft2009Objectives.pdf

Or,...you can go to the following webpage to review the objectives and comment directly:
http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspx

Note that Healthcare IT and Hospital Aquired Infections are established objectives in Healthy People 2020.

The entire press release from the AHRQ is below:

Opportunity for public comment on draft Healthy People 2020 objectives

The U.S. Department of Health and Human Services invites you to comment on the DRAFT set of objectives for Healthy People 2020. For three decades, Healthy People has provided a set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans.

Visit www.healthypeople.gov/hp2020 to
· View proposed draft objectives for Healthy People 2020
· Comment on the proposed objectives
· Comment on the topic areas
· Suggest additional objectives
· Suggest topic areas you feel are missing from the draft set

Your comments will help ensure issues important to you are included in Healthy People. Establishing objectives and providing benchmarks to track progress motivates, guides, and focuses action. Be part of the change. Comments will be accepted through December 31, 2009.

Visit www.healthypeople.gov/hp2020 today. Your feedback will help define the vision and strategy for building a healthier Nation.

AHRQ Tools and Resources to Prevent HAIs.

In early September, the AHRQ released a webpage highlighting research and resources related to the prevention of hospital acquired infections. This is an excellent site that links to tools and resources for both healthcare providers as well as healthcare consumers.

You can find the website here.

Hospital Aquired Conditions Section @ National Guideline Clearinghouse

Most of us are probably aware of www.guidelines.gov as being a searchable clearinghouse of evidence-based clinical practice guidelines.

Did you know that there is a section specifically about preventing the hospital acquired conditions that CMS says they will no longer pay for?

http://www.guideline.gov/resources/hac.aspx


It appears that they (National Guidelines Clearinghouse (NGC), an initiative of the Agency for Healthcare Research and Quality (AHRQ)) intends to keep this page current. The most recent update was July 27th.

AHRQ says Health Care Quality in Indiana is "Weak".

After compiling over 100 measures for all states, Indiana falls between weak and average on the National Health Care Quality Report (NHRQ) - a report funded by the Agency for Health Care Research and Quality (AHRQ).

You can view the dashboard and the elements that contribute to Indiana's overall score here.