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Care Transitions is a Centers for Medicare & Medicaid Services quality improvement project administered through TMF Health Quality Institute for Texas' Lower Rio Grande Valley. It is a regional, collaborative effort to reduce avoidable hospitalizations by improving patient care transitions. |
| Issue 1, Volume 1 |
November 2008 |
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In This Issue
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U.S. Health Care Needs to Change Says Commonwealth Fund's President
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Also in the News: personal health records, anticoagulant alert, e-prescribing 2009, physician performance incentives
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Home Health: ICD-9-CM updated PPS grouper
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Hospitals: HAC/POA reporting site updates, new hospital accreditation organization, benchmarks tool, AMI and HF measures changes, HF measures success story, value-based purchasing demonstration
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Skilled Nursing Facilities: new 5-star ratings, increased Medicare payments, licensure and Medicaid certification amendments
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Care Transitions News is brought to you by:
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 U.S. Health Care Needs to Change Says Commonwealth Fund's President
A recent Commonwealth Fund survey shows Americans believe it's important to seek reforms that address health care quality, access and costs. Read Commonwealth Fund President Karen Davis' column. |
Medicare Pilot Program Will Offer Beneficiaries Choices for Maintaining Their Own Personal Health Records
Under a CMS pilot program in Arizona and Utah, beneficiaries may choose one of several selected commercial personal health record (PHR) tools and Medicare will transfer up to two years of the individual's claim data into the PHR. Depending on the PHR tool selected, patients may be able to authorize links to other personal electronic information such as pharmacy data. Full article.
Joint Commission Alert: Prevent Blood Thinner Deaths and Overdoses
The Joint Commission's new Sentinel Event Alert urges greater attention to the dangers associated with anti-coagulants, life-saving medications that also present serious risks when administered incorrectly or in error. Patients being treated with these medications must be closely monitored and screened for drug and food interactions. Anticoagulant medication errors are such a serious patient safety issue that the Joint Commission addresses these types of errors in the 2008 National Patient Safety Goals, with full implementation of the requirements expected by January 1, 2009. Read the Joint Commission anticoagulant alert.
E-Prescribing Initiative Starting Next Year
Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible physician practices that are successful electronic prescribers. Eligible professionals will receive a 2 percent incentive payment in 2009 and 2010, 1 percent in 2011 and 2012, and 0.5 percent in 2013. Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a reduction in payment. See Physician Quality Reporting Initiative, E-Prescribing Incentive on the CMS Web site.
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Physician Groups Earn Performance Payments for Improving Quality of Care for Patients with Chronic Illnesses
CMS announced last summer that 10 physician groups participating in the Physician Group Practice (PGP) Demonstration earned $16.7 million in incentive payments. Practices earned the incentives for improving the quality of care delivered to patients with congestive heart failure, coronary artery disease and diabetes mellitus. Full article.
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| HOME HEALTH |
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CMS Updates Home Health PPS Grouper
The Centers for Medicare & Medicaid Services (CMS) has updated the Home Health (HH) Prospective Payment System (PPS) Grouper due to changes in ICD-9-CM coding (which became effective October 1, 2008). CMS provides an updated HH PPS Grouper Software Package (Version 2.03) and changes are described in the README file (READM203.PDF). Access the package in the downloads section. |
| HOSPITALS |
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Update of the HAC/POA Reporting Web Site
CMS recently updated all sections of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting Web site to describe the changes published in CMS' Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule. View the HAC and POA indicator information.
Medicare Approves New Hospital Accreditation Organization
CMS announced in September its approval of the first new hospital accreditation organization in more than 30 years. DNV Healthcare Inc. can now evaluate hospitals for compliance with Medicare Conditions of Participation. Full article. Hospital Benchmarks (Tool)
This Excel spreadsheet contains the most current quarter available for benchmarks of hospital-abstracted AMI, heart failure, SCIP, pneumonia, and appropriate care measure (ACM) data for PPS-only and combined CAH and PPS hospitals. See the benchmarks tool.
AMI and HF Measures Changes for 10/1/08+ (Fact Sheet and Presentation)
Not only does this link provide a summary of changes, but you'll also find a link to the Specifications Manual for National Hospital Quality Measures for discharges post-October 1, 2008. Fact sheet and presentation. Success Story: Pulaski Community Hospital Improves Heart Failure Core Measures
This 147-bed hospital aimed to improve and sustain the hospital's heart failure core measures performance. They set as a goal to perform in the top 10 percent in the nation. Pulaski reached its goal through collaboration with its Quality Improvement Organization (QIO), administration commitment and staff accountability. Learn how this QI team succeeded.
Value-Based Purchasing Demo Shows More Improvements in Hospitals
The latest results of the Premier Hospital Quality Incentive Demonstration (HQID) show dramatic across-the-board improvement in the performance of participating hospitals. The HQID involves about 250 hospitals in 36 states. CMS has awarded more than $24.5 million over the first three years of this project. Learn more about the Value-Based Purchasing demonstration.
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| SKILLED NURSING FACILITIES |
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CMS to Rate Nursing Home Quality with 5-Star System
CMS will soon launch a ranking system of America's nursing homes, giving each a "star" rating. The system is designed to provide residents and their families with an easy-to-understand assessment of nursing home quality. For more information on the 5-star rating system, see the CMS "Hot Topics" Web page.
Medicare Increases Nursing Home Payment Rates, Recalibration of RUGS to Be Studied Further
Payment rates to nursing homes will increase by $780 million next year. The boost is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay. Full article.
Proposed Amendments to Nursing Facility Requirements for Licensure and Medicaid Certification
The Health and Human Services Commission, on behalf of the Department of Aging and Disability Services, proposes 40 amendments to Texas administrative codes. All proposed amendments are within Chapter 18, Nursing Facility Administrators. The proposed rules were published October 24, 2008 in the Texas Register. The last day of the 30-day public comment period is November 23, 2008. Access the proposed rules through this Texas Register link. | |
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This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 9SOW-TX-CT-08-09
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