patient safety science & technology summit 2014
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Patient Safety Science & Technology Summit 2014. Patrick Conway, MD, MSc. Chief Medical Officer, Centers for Medicare and Medicaid Services. Patient Safety Efforts at CMS. Discussion. Quality Levers Quality Improvement Organization funding Clinical Standards and Survey and Certification - PowerPoint PPT PresentationTRANSCRIPT
2014 Summit Co-Convener:Founder:
Patient Safety Science & Technology Summit2014
2014 Summit Co-Convener:Founder:
Patrick Conway, MD, MScChief Medical Officer, Centers for Medicare and Medicaid Services
2014 Summit Co-Convener:Founder:
Patient Safety Efforts at CMS
2014 Summit Co-Convener:Founder:
Discussion• Quality Levers
– Quality Improvement Organization funding– Clinical Standards and Survey and Certification– Value-based Purchasing
• CMS Innovation Center– New Models of Care Delivery– Partnership for Patients
• Future Vision
2014 Summit Co-Convener:Founder:
Our AimsBetter Health forthe Population
Better Carefor Individuals
Lower CostThrough
Improvement
2014 Summit Co-Convener:Founder:
The Six Goals of the CMS Quality Strategy
1
2
3
4
5
6
2014 Summit Co-Convener:Founder:
Quality Improvement Organization Work to Reduce Harm
• There are 53 Quality Improvement Organizations (QIOs) across 50 states and territories
• Hundreds of millions of dollars in QI investment• Focused on multiple areas of harm and demonstrating results such
as:– 53% Relative Improvement Rate in the reduction of Central-line
associated bloodstream infections– Over 85,000 fewer days with urinary catheters for beneficiaries
• Hospitals with higher than expected rates targeted
2014 Summit Co-Convener:Founder:
Nursing Home Highlight: Quality Care Collaborative
• Ensure that every nursing home resident receives the highest quality of care.
• Strives to instill quality and performance improvement practices, eliminate healthcare acquired conditions, and dramatically improve resident satisfaction
• Over 5000 nursing homes engaged and generating results– Decreased anti-psychotic use in dementia residents– Decreased pressure ulcers and falls– Reduction in healthcare acquired infections and conditions
2014 Summit Co-Convener:Founder:
Reduced Potential for Adverse Drug Events
2,629more beneficiaries
haveINRs within
Therapeutic Range
2014 Summit Co-Convener:Founder:
2,966 Pressure Ulcers
Prevented or Healed
2014 Summit Co-Convener:Founder:
QIO Program Culture Change: Next Generation of Work• Next statement of work was released in Dec 2013• Support Beneficiaries and their families and engage patients in all improvement
activities• Learning collaboratives to drive transformation• Innovative ideas flow from the field• Measure and review often, while responding quickly to data• High reliability methods and utilize implementation science• Leverage partnerships and collaborations to drive improvement• Clear aims and continuous testing and learning to improve results
2014 Summit Co-Convener:Founder:
Clinical Standards and Survey and Certification• Responsible for quality and safety standards for providers (Conditions of
Participation) and their enforcement• Significantly updated Hospital Conditions of Participation with more to come
in the future
• Working to update Home Health and Long-term care clinical standards• Survey and Certification guidance and enforcement (e.g. working to finalize
guidance on inpatient monitoring)• Work with accreditors such as Joint Commission on shared goals of improved
quality and safer systems
2014 Summit Co-Convener:Founder:
Transparency and Value-based Purchasing
• Hospital Compare and other websites with performance measures and downloadable raw data (e.g. HAIs, patient safety composite)
• Hospital Value-based purchasing with over $1 billion allocated to hospitals based on performance on quality and efficiency measures (including patient safety)
• Finalized measures for the Healthcare Acquired Condition program which will negatively adjust payment by 1% to the bottom quartile of performers on key HAI measures and patient safety composite
2014 Summit Co-Convener:Founder:
National Results
• Over 44% reduction nationally in central line associated bloodstream infections
• Over 22% reduction nationally in surgical site infections
• Positive results in multiple other areas of harm
2014 Summit Co-Convener:Founder:
Discussion• Quality Levers
– Quality Improvement Organization funding– Clinical Standards and Survey and Certification– Value-based Purchasing
• CMS Innovation Center– New Models of Care Delivery– Partnership for Patients
• Future Vision
2014 Summit Co-Convener:Founder:
Delivery system and payment transformation
Future State – People-Centered Outcomes Driven Sustainable Coordinated Care SystemsNew Systems and ApproachesValue-based purchasingACOs Shared SavingsEpisode-based paymentsMedical HomesState InnovationData Transparency, etc
Current State – Producer-Centered
Volume Driven
Unsustainable
Fragmented Care Systems
FFS Payment Systems
2014 Summit Co-Convener:Founder:
CMS Innovations Portfolio: Testing New Models to Improve Quality
Accountable Care Organizations (ACOs)• Medicare Shared Savings Program (Center for Medicare)• Pioneer ACO Model• Advance Payment ACO Model• Comprehensive ERSD Care Initiative
Primary Care Transformation• Comprehensive Primary Care Initiative (CPC)• Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration• Federally Qualified Health Center (FQHC) Advanced Primary Care
Practice Demonstration• Independence at Home Demonstration • Graduate Nurse Education Demonstration
Bundled Payment for Care Improvement• Model 1: Retrospective Acute Care • Model 2: Retrospective Acute Care Episode &
Post Acute• Model 3: Retrospective Post Acute Care• Model 4: Prospective Acute Care
Capacity to Spread Innovation• Partnership for Patients • Community-Based Care Transitions• Million Hearts
Health Care Innovation Awards
State Innovation Models Initiative
2014 Summit Co-Convener:Founder:
Innovation is happening broadly across the country
2014 Summit Co-Convener:Founder:
Partnership for Patients
• 40% Reduction in Preventable Hospital Acquired Conditions– 1.8 Million Fewer Injuries– 60,000 Lives Saved
• 20% Reduction in Preventable 30-Day Readmissions– 1.6 Million Patients Recover Without Readmission
• CMS investing almost $1 billion• Potential to save billions• Broad national engagement – almost 80% of hospitals as well as
consumers, employers, payers, and others
2014 Summit Co-Convener:Founder:
Ten Areas of FocusHospital Engagement Networks are required to address ten areas of focus: •Adverse Drug Events•Catheter-Associated Urinary Tract Infections•Central Line Associated Blood Stream Infections•Injuries from Falls and Immobility•Obstetrical Adverse Events•Pressure Ulcers•Surgical Site Infections•Venous Thromboembolism•Ventilator-Associated Pneumonia•Preventable readmissions
2014 Summit Co-Convener:Founder:
Medicare All Cause, 30 Day Hospital Readmission Rate
2014 Summit Co-Convener:Founder:
Partnership for Patients: Over 3500 Hospitals Reducing Harm and Improvement Accelerating
2014 Summit Co-Convener:Founder:
The “3T’s” Road Map to Transforming U.S. Health Care
Key T1 activity to test what care works
Clinical efficacy research
Key T2 activities to test who benefits from
promising care
Outcomes researchComparative effectiveness
Research
Health services research
Key T3 activities to test how to deliver high-quality
care reliably and in all settings
Quality Measurement andImprovement
Implementation of Interventions and health care system redesign
Scaling and spread of effective interventions
Research in above domains
T1 T2 T3Basic biomedical
scienceClinical efficacy
knowledgeClinical effectiveness
knowledge
Improved health care quality &
value &population health
Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”
2014 Summit Co-Convener:Founder:
Future Vision• Technology and innovation focused on eliminating patient harm
• Best practices spread rapidly
• Payment and incentive systems reward eliminating harm and improved patient outcomes
• Electronic health records, monitoring, and data analytics utilized to drive improvement
• Learning from other industries (e.g., reliability science, LEAN, etc) applied to health care
• Systems redesign achieves better health, better care, and lower costs through improvement
2014 Summit Co-Convener:Founder:
Contact Information
Dr. Patrick Conway, M.D., M.Sc.CMS Chief Medical Officer
CMS Deputy Administrator for Quality and Innovation
2014 Summit Co-Convener:Founder:
Patient Safety Science & Technology Summit2014