March 2005, In This Issue:
- HPCI Sets 2005-2006 Priorities
- Consumers' Health Care Guide for Greater Iowa
- New Launch for Leapfrog Group Hospital Survey
- Calls for Action: Going LEAN in Health Care
- Iowa Hospitals Begin LEAN Journey
- The Business Case for Quality and LEAN Enterprise
- The State of the Art of On Line Hospital Public Reporting: A Review of 47 Websites
- Iowa Hospitals Report on CMS "Starter Set"
- Study Shows Employees Willing to Take a Greater Health Care Responsibility
- Agency for Health Care Research and Quality (AHRQ) Buy-Right for Health Care Quality: Evidence and Indicators
- Humana to Test Health-Care Evaluation System
- Tracking Health Care Costs
- Minnesota's Smart Buyer Alliance
- Praise for Adverse Health Events Reporting
Based upon input from the survey of member contributors and project supporters the 2005/2006 priorities for HPCI have been identified. Details on these will be forwarded to supporters soon and are available through the HPCI office.
HPCI and the Iowa Health Care Buyers Alliance will be publishing its first Consumers' Health Care Guide for 2005. HPCI is a co-sponsor of the Iowa Health Buyers Alliance. The Alliance and HPCI will provide this Guide as an information source on health care performance and prevention to help members and their families make better health care choices and to improve their overall health status.
Over time, the Guide or series of Guides will include information on overall health care providers performance as well as information on prevention and lifestyle. It will include data describing health care providers and health plans in the greater Iowa market area. The first edition, to be published this year, will include hospital specific performance data available at this time: 1) CMS "Starter Set", 2) Joint Commission's Quality Check, 3) Leapfrog Group Hospital Reports, and 4) information on the Heart Value Partnership and/or data on heart care.
Beginning March 15, 2005, the Leapfrog Group is launching the new hospital survey. The Leapfrog Group, founded by the Business Roundtable, is a prominent regional and national force working to initiate breakthrough improvements in safety, quality and efficiency of health care. Its focus is on patient safety: rewarding higher standards. HPCI is an active member of the Leapfrog Group and an Iowa effort sponsor.
The Leapfrog Group provides the public reporting vehicle for the National Quality Forum's (NQF) 30 Safe Practices for Better Health Care. There is a broad consensus for these safe practices.
On behalf of over 40 Iowa employers, HPCI joined the Iowa Buyers Alliance last year requesting the 26 larger Iowa hospitals participate in the Leapfrog Group Hospital Survey reporting. Work is continuing on three fronts: 1) providing support and assistance to those hospitals actively considering reporting, 2) sharing and exchanging information and education to all stakeholders and to the general public and 3) including the Leapfrog Group hospital specific information in the 2005 Consumers' Guide.
For rural hospitals, not all Leapfrog Leaps apply. The Quality Index (made up of 27 of NQF endorsed practices) is the first Leap that applies to all hospitals including rural hospitals. Over 1,000 U.S. hospitals are currently participating in the Leapfrog hospital reporting.
The Institute for Health Care Improvement (IHI), highly regarded by health professionals and others, recently launched a new series "Calls to Action, Going LEAN in Health Care". In their announcement IHI indicated they "have teamed up with leading experts in LEAN thinking to help you significantly improve quality and reduce cost by implementing a comprehensive strategy to drive out waste in your organization. You will learn how to apply waste reduction principles that have been successfully deployed in other industries."
The IHI series includes sessions on: 1) eliminating waste in our systems, 2) dramatic results by driving out waste and 3) driving out waste becomes the strategy for health care organizations. This third session featured Virginia Mason Medical Center in Seattle, Washington and ThataCare Inc., Appleton, Wisconsin.
Numerous Iowa hospitals have begun the LEAN journey to realize significant improvements in their processes. These include the University of Iowa Hospitals and Clinics, Unity Health System in Muscatine, Mercy and St. Luke's Hospitals in Cedar Rapids, and Mercy Medical Center in Des Moines. A number of other Iowa hospitals have expressed interest. Congratulations to all.
At Virginia Mason Medical Center in Seattle, the business case for quality and LEAN methods is clear according to Gary Kaplan, MD, Chairman and CEO. It includes: 1) the cost of errors in terms of death, disability, financial cost, and professional liability expense, 2) leveling off of staffing trends (FTEs), and 3) cost avoidance. They have realized millions of dollars in capital costs savings while at the same time reducing lead time and patient travel.
The Delmarva Foundation along with the Joint Commission on Accreditation of Health Care Organizations recently published its findings in a report entitled The State of the Art of On Line Hospital Public Reporting: A Review of 47 Websites.
On line hospital specific performance reporting is increasingly available for Iowa hospitals and others across the U.S. The report points out that hospitals nationwide join a growing list of health care organizations that publicly report performance information as a result of law or regulation, employer or consumer projects, voluntary efforts, or commercial enterprise. Found on a wide variety of websites, hospital performance information includes comparative data on clinical performance, patient safety, patient satisfaction and other measures.
Consumers were identified as the primary audience for most of the websites (indicated by 37 of the sites). In addition to the word "consumer", other terms include: patients, residents, citizens, people, enrollees, members, employees and those who receive and pay for care. The purpose of the sites for consumers includes helping them make informed decisions (commission by more than half of the websites) and various other purposes.
Most Iowa hospitals are now beginning to report their individual hospital performances for 10 measures of good medical treatment for three common, but serious conditions: acute heart attack, congestive heart failure and pneumonia. These conditions are the so-called CMS "Starter Set". More such measures are expected to be publicly reported in the future.
Information can be found at www.cms.hhs.gov/quality/hospital. HPCI and the Iowa Health Buyers Alliance will be incorporating these hospital performance measures in the 2005 Consumers' Health Care Guide for Greater Iowa.
Employees are willing to assume greater responsibility for health care than employers might think, according to a recent study by Hewitt Associates.
Employees need support to move toward greater consumerism. That is the conclusion of the study. Hewitt's national survey of more than 39,000 employees found that while 93% of employees indicate that they are comfortable taking more responsibility for health care decisions, most struggle with how to do so.
More than half (57%) have never researched provider cost or quality, and nearly a quarter (24%) have never asked about their prescription drug options. Furthermore, less than half say they do a great job of taking preventive medicines, screening tests or immunizations recommended by their doctor, and those in the poorest health are least likely to do so.
Hewitt indicated that "while it is great to hear that employees are willing to move to a more consumer oriented system, this is a wake up call that we need to help employees move to a place where they are researching and understanding their health care choices, giving these important decisions as much attention as they deserve."
As health care costs continue to escalate and as shortfalls in the quality of care continue, employers and other purchasers are pursuing "Quality-Based Purchasing" strategies. Though many purchasers have begun to implement such programs, the evidence base in support of them has not been well articulated according to the AHRQ. "Moreover, because of the amount of hospital quality information that is being collected and public reporting is growing rapidly, purchasers and other stakeholders need information to guide their selection and use of appropriate quality measures."
The AHRQ is sponsoring efforts to help purchasers understand the evidence base for quality-based purchasing and public reporting to increase their understanding of an important tool set available to assist them with the evaluations of health care quality. HPCI and the Iowa Health Buyers Alliance are using this information as part of their program and project initiatives. For more information regarding the Agency for Health Care Research and Quality, visit www.ahrq.gov
A Rand study last year found that adults get the care recommended by clinical guidelines about half of the time. The study was based on medical records of thousands of patients.
Humana will be the first health benefits company to test software developed by the Rand Corporation to determine whether consumers are getting appropriate health care. Software will be run on Humana data to produce quality-of-care scores for physicians in various specialties. Rand and Humana will then determine how well the software works and how it might be used by insurers and others.
Health care costs per private insured American increased 7.5% during the first half of 2004 - virtually the same rate of increase as in 2003 according to the Center for Studying Health System Change. According to the Center, "Health care costs likely will continue to grow faster than workers' income for the foreseeable future, leading to greater numbers of uninsured Americans and raising the stakes for policy makers to initiate effective cost-containment policies or accept the current trend of rapidly growing health costs and gradually shrinking health benefits".
Growth in spending on hospital inpatient care slowed to 5.1% in the first half of 2004, while the trend for outpatient spending held steady at 11.4%. With hospital utilization continuing to grow at a slow rate for the second year in a row, hospital prices increase accounted for much of the hospital spending increase, which were 7% in the first half of 2004. Spending on prescription drugs increased 8.8% in the first half of 2004, similar to the increase in the first and second half of 2003 and substantially below the peak increase of 19.5% in the second half of 1999.
Minnesota Governor Pawlenty announced the formation of the Minnesota Smart Buyers Alliance in late 2004. It is a group of health care purchasers representing roughly 3.5 million Minnesotans - from state government to small businesses to labor groups. They will use State and private health care purchasing power to drive much needed value reform.
The Chairman of Communication for the Minnesota Council of Health Plans said that the health plans have long been interested in such initiatives. "The Governor's efforts bring momentum and focus to promote positive change. We are in the business of responding to customers. We are relying on customers to say `this is how we want the market to move'."
In addition to the Business Partnership, the Alliance includes state government, the Minnesota Chamber of Commerce, the Minnesota Association of Professional Employees, the Employers Association, the Labor/Management Health Care Coalition of the Upper Midwest and the Buyers Health Care Action Group.
The first-in-the-nation report on preventable medical errors-or adverse events- issued by the Minnesota Department of Health is a major step forward in improving the quality of health care for all Minnesotans, according to the Smart Buyer Alliance. "These are the kind of medical errors that should never happen. The Minnesota Hospital Association deserves a great deal of credit for stepping up to the plate and being accountable" said the Commissioner of Employee Relations and a member of the Alliance. "This is the beginning of measuring results in health care-not just costs."
"It is our hope that these adverse reports will be released each year and that health care providers will use the information to reduce errors and increase quality" said Carolyn Pare, CEO of Buyers Health Care Action Group a large employer coalition and another member of the Alliance. "Reporting this kind of medical errors is a historic first step in providing the kind of information consumers need to buy on the basis of quality."
Under legislation adopted in 2004, the Minnesota Department of Health is required to track and report in the occurrence of 27 serious medical errors that should never happen. These "never events" include leaving medical instruments in patients, surgery on the wrong body part, and a range of other events.
While Minnesota is the first state to take action and actually report publicly on these standards developed by the National Quality Forum (NQF), it is being joined by others. New Jersey and Connecticut have also adopted standards to report errors which are also being considered elsewhere. The Des Moines Register, in its January 25, 2005 editorial entitled "Shine Light on Medical Errors" supported these efforts and called for the State of Iowa to do the same. "A system that tracks medical errors and makes the information accessible to the public would benefit patients and hospitals" the paper said.
In 1999 the Institute of Medicine estimated 98,000 Americans die annually because of medical mistakes in hospitals. Since then, 22 states have adopted laws requiring hospitals to report serious mistakes according to the National Academy for State Health Policy.
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