Efforts to Improve Patient Safety Result in 1.3
Million Fewer Patient Harms, 50,000 Lives Saved and $12 Billion in Health
Spending Avoided
A report recently released by the Department of Health and
Human Services shows an estimated 50,000 fewer patients died in hospitals and
approximately $12 billion in health care costs were saved as a result of a reduction
in hospital-acquired conditions from 2010 to 2013. This progress toward a
safer health care system occurred during a period of concerted attention by
hospitals throughout the country to reduce adverse events. The efforts were
due in part to provisions of the Affordable Care Act such as Medicare payment
incentives to improve the quality of care and the HHS Partnership for
Patients initiative. Preliminary estimates show that in total, hospital
patients experienced 1.3 million fewer hospital-acquired conditions from 2010
to 2013. This translates to a 17 percent decline in hospital-acquired
conditions over the three-year period. "Today's results are welcome news
for patients and their families," said HHS Secretary Sylvia M. Burwell.
"These data represent significant progress in improving the quality of
care that patients receive while spending our health care dollars more
wisely. HHS will work with partners across the country to continue to build
on this progress." (HHS.gov, December 2, 2014)
Pay for Performance Pays off in 50,000 Fewer Deaths
Martin Merritt, JD, applauds the news from CMS cited in the above report.
"Critics will certainly argue along the lines of the famous Ronald Coase
observation, 'If you torture data long enough, it will confess to anything.'
This may be one time, however, when it is OK to be less philosophical. Rarely
does the federal government hand physicians a tool that makes life a little
better. That's what Office of Inspector General (OIG) Advisory Opinion 12-22 does, and now data backs up the
theory, with numbers showing lower program costs, lower injuries and deaths,
and greater patient satisfaction." Merritt goes on to explain how
relaxed pay-for-performance regulations have engineered the saving of these
50,000 lives. He concludes that "…the OIG had to approve of sharing
compensation between the facility and the physicians. Happily, the data
suggesting 50,000 lives saved, means the OIG and HHS got one right this
time." ( Physicians Practice, December 14, 2014)
How Quality Incentive Payments Vary by Physician
Specialty and Position
The Sullivan Cotter & Associates' 2014 Physician Compensation and
Productivity survey reports that primary care department chairs have
the highest median quality incentive payments among all physician specialties
and positions. Surgical specialties see the highest median quality incentive
payments.
Check out the graph below, modified from the Sullivan Cotter & Associates'
survey.
(Becker's Hospital Review, 2014)
Health Care Pros Confirm It: Coordinating Care of
Older Adults Moving Across Treatment Remains a Problem with No Easy Answers:
Experts Urge Caution in Implementing Pay-for-Performance Schemes Tied to
Coordinating 'Transitional Care' of Older Adults
Alicia Arbaje, MD, MPH, director of transitional care research and assistant
professor of medicine at Johns Hopkins Bayview Medical Center and the Johns
Hopkins University School of Medicine, was the principal author of "Excellence
in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of
Health Care Professionals" published in the December issue of the Joint
Commission Journal on Quality and Patient Safety. An MDLinx summary of
the article follows:
SUMMARY: A study was conducted to characterize health care
professionals' perspectives on successful transitional care of older adults
(age 65 years and older), suggestions for improvement, and P4P strategies
related to transitional care. This study suggests that in characterizing
health care professionals' perspectives, specific care processes to target,
challenges to address in the design of P4P strategies, and unmet needs to
consider regarding education and feedback for health care professionals were
described. Future investigations could evaluate whether performance targets,
educational interventions, and implementation strategies based on this
conceptual framework improve quality of transitional care. (Summary from MDLinx on 12/18/2014)
While the article is only available for purchase at the moment, Johns Hopkins
issued a release providing details on the study and its results.
According to the release, "the authors note the persistent 'mixed
reviews' of the impact of tying compensation to quality of care. They also
say that care transitions across health care settings remain "common,
complicated, costly and potentially hazardous for older adults." As the
ranks of older adults grow and their numerous illnesses require ever more
drugs, specialists and facilities, poor transitional care frequently leads to
rehospitalizations and complications for patients." (Johns Hopkins
Medicine, November 25, 2014)
Reforming Graduate Medical Education in the U.S.
Abstract: The foundation of the U.S. health care system is a
workforce of highly competent doctors who are prepared to provide the highest
quality health care when they enter practice. However, there is increasing
concern that the current system for training doctors following graduation
from medical school falls short in terms of producing an adequate workforce
to meet the nation's changing health care needs. Reforming the graduate
medical education system will require accurate data on the true costs of
training physicians, greater oversight and accountability, and a transition
from the current outdated financing system that is based mainly on federal
support to a system that is more equitably distributed among stakeholders and
where the funding is controlled by the states and follows the trainee.
(The Heritage Foundation, December 29, 2014)
Health Care Services Gap Narrows between Whites and
African-Americans
A University of Pittsburgh study has found that nationwide disparities in the
quality of hospital care between whites and minorities have decreased for
those with acute myocardial infarction, heart failure and pneumonia. The Pitt
study, "Quality and Equity of Care in U.S. Hospitals," showed
progress from 2005 to 2010 with "increased racial and ethnic
equity" for hospitalized African-American and Hispanic adults, as
compared with white patients. Reductions in disparities between race and
ethnic groups resulted from "more equitable care for white patients and
minority patients treated in the same hospital," and "greater
performance improvements among hospitals that disproportionately serve
minority patients," states the study, led by Michael J. Fine, a
professor of medicine at the Pitt School of Medicine. The study also involved
researchers from Brown University, the Centers for Medicare and Medicaid
Services and various veteran health centers. According to the study,
"Equity is a key dimension of health care quality. Therefore, efforts to
gauge progress in quality of care must include explicit considerations of
whether gains have also occurred in health care equity." ( Pittsburgh
Post-Gazette, December 30, 2014)
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