September 12, Dear Dr. Corrigan:

Size: px
Start display at page:

Download "September 12, 2011. Dear Dr. Corrigan:"

Transcription

1 September 12, 2011 Janet M. Corrigan, PhD, MBA President and Chief Executive Officer National Quality Forum th Street, NW Suite 500 North Washington, D.C Re: Measure Applications Partnership Report Coordination Strategy for Healthcare-Acquired Conditions and Readmissions Across Public and Private Payers Dear Dr. Corrigan: The American Association of Orthopaedic Surgeons (AAOS) appreciates the opportunity to comment on the report entitled, Coordination Strategy for Healthcare-Acquired Conditions and Readmissions Across Public and Private Payers submitted by the Measure Applications Partnership (MAP). The AAOS represents approximately 18,000 board-certified orthopaedic surgeons and has been a committed partner to the National Quality Forum (NQF) in patient safety and quality health care. We look forward to providing input on the MAP recommendations for coordinating strategies to reduce healthcare-acquired conditions (HACs) and readmissions. General Comments The AAOS commends MAP on the immense effort of formulating the proposed

2 recommendations and drafting the report, which provides a coordination strategy on alignment of performance measurement and other approaches for addressing HACs and readmissions across public and private payers. The AAOS supports quality measures that are actionable and help align and coordinate care in all settings by all providers. We support the measurement and reduction of complications and readmissions. We have concerns, however, with the ability of an overall performance rate on a measure or set of measures to inform a hospital/provider of its specific needs for quality and patient safety improvement. Core Set of Safety Measures The first recommendation urges development and maintenance of a national core set of safety measures that are applicable to all patients. The AAOS agrees that measurement information should be evidence-based and clinically relevant to providers to support quality improvement. The AAOS believes aligning quality reporting measures across all settings of care is a complicated task, and the AAOS asks that NQF/MAP take a cautious approach and start by focusing on the HACs and readmissions that can be adequately measured, have evidence-based guidelines and are able to be accurately risk-adjusted. The recommendation states that the core measures should be consistent across the care continuum promoting shared accountability among providers across settings. The AAOS agrees that creating a healthcare system that supports shared accountability is essential to improving patient outcomes and reducing HACs and readmissions. The AAOS would like to highlight that there is shared accountability in delivering preventive services and in a patient s treatment and diagnosis. Typically, a team of providers care for the patient. In our fragmented system, however, a shared team approach to healthcare is not well established. We would encourage caution in developing policy that may hurt the team approach to care through inequitable attribution. Accurate attribution should be an element of performance assessment and quality improvement initiatives. This recommendation suggests that public reporting of performance on the core measure set should include understandable information and be disseminated broadly. The AAOS urges that safety information be made available to purchasers and consumers only after the providers have had an opportunity to review reports related to their performance and have had an opportunity to correct any misinformation or incorrect information in the report. NQF/MAP must take into consideration the negative impact that an unfavorable report could have on providers, and every effort must be made to provide accurate, verified reports.

3 Data Elements Collection The second recommendation states that data elements needed to calculate the measures in the safety core set should be collected on all patients. The AAOS agrees that developing a national safety data strategy within the context of a broader national data strategy is essential for coordination of safety measurement and improvement efforts. The AAOS, however, is concerned about the overall quality of data collection. Differences in data collection mechanisms and processes introduce variation in results unrelated to actual performance. In addition, the AAOS encourages NQF/MAP to be cognizant of the fact that administrative claims may not give the information that is needed to fully and accurately assess providers performance or properly characterize readmissions. Considerations in the selection of measures for a quality reporting program must be applied with an appreciation for factors that distinguish each provider or facility from others. In order to promote broad participation in the quality reporting system, this diversity, which has important implications for the development of data completeness standards, must be considered in the selection of the measure set. The AAOS supports harmonization of the reporting processes for current databases maintained by federal agencies, including those of the Agency for Healthcare Research and Quality s Healthcare Cost and Utilization Project, the Centers for Disease Control and Prevention s National Healthcare Safety Network, CMS s Hospital Compare, and the U.S. Food and Drug Administration s Sentinel Initiative. The AAOS, however, questions whether a goal of 100 percent reporting is realistic, or even feasible, given the nascency of electronic health record technology. Another key component of the data platform is that it would enable collection of patient-reported information, which can be particularly important for reducing readmissions, by understanding problems that arise during care transitions. The AAOS suggests that patient-reported information could also require patients to document their compliance with discharge plans/instructions. Public-Private Sector Coordination The AAOS shares NQF s goal of promoting high quality, safe and effective care. The AAOS generally supports the MAP s third recommendation, which supports coordination of public-and private-sector entities in efforts to make care safer, and urges development and implementation of standardized discharge plan elements incorporating best practices for care transitions. The AAOS, however, cautions NQF/MAP to proceed slowly in developing coordinated incentive

4 structures designed to prevent adverse safety events. The AAOS is concerned about programs that may penalize providers who are not actually responsible for the safety event. Applying a healthcare-associated condition policy requires analysis and discretion, as well as accurate attribution. The AAOS urges that only events or conditions that are immediately or irrefutably attributable to the service being provided lead to penalties or other reduction or elimination of payment/reimbursement. This third recommendation advocates providing resources to patients to help ensure patients fully understand the role they should play in maintaining their health and determining their healthcare needs. The report espouses a delivery system with better and more information for consumer decision making and heightened accountability for clinicians and providers. The AAOS believes the report falls short on acknowledging the critical role patients play in determining their own healthcare outcomes. Successful surgical outcomes, particularly those in the outpatient and ambulatory settings, are heavily reliant on patient responsibility and accountability. Patients are not merely consumers making decisions about healthcare purchases. They must be seen as sharing the responsibility for their own outcomes. The AAOS believes that providers and purchasers in collaboration with medical communities can take actions to improve health care delivery and reduce readmissions by ensuring that patients are clinically ready at discharge, reducing the risk of infection, reconciling medications, and improving communications among providers involved in transition of care. The AAOS recognizes, however, that there are many factors beyond the providers /hospitals control that may impact rates of readmission, including the patient s own behavior. We are committed to patient-centered care, yet we are concerned that our current health care system has a minimal culture of patient accountability. Before proceeding with implementation of readmissions measures, NQF should consider the necessary resources, structure, and cultural changes necessary to reasonably implement a meaningful policy. Hospital-Acquired Conditions The AAOS is very supportive of NQF s efforts to encourage the adoption of evidence-based treatment guidelines which could improve the quality of care for our patients. However, we are concerned with the presumption that all of the HACs cited in the report could be reasonably prevented through the use of evidence-based guidelines. The AAOS believes there is an important distinction between reduction and preventability. While evidence-based

5 guidelines can reduce incidence, they cannot completely eliminate the risk of certain hospital-acquired adverse events. To be reasonably preventable a HAC should have solid evidence published in peer-reviewed literature that by following certain guidelines the occurrence of an event can be reduced to zero or near zero among a typically broad and diverse patient population including high-risk patients. The MAP and the Partnership for Patients initiative focus on nine HACs, including surgical site infections and venous thromboembolism. Surgical Site Infections The AAOS agrees that surgical site infection is a serious patient safety concern. Infection, however, is a multidimensional condition with many contributing factors. Patients have varying degrees of susceptibility to infection. Prior open surgical procedures, immunosuppressive therapy, poor nutrition, hypokalemia, diabetes mellitus, obesity, current or historical nicotine use, prior incidence of infection, corticosteroid use, extremes of age, rheumatoid arthritis, and prolonged perioperative hospitalizations are some of the factors that increase the risk of surgical site infection in orthopaedic procedures. An all-or-nothing policy can punish providers even if they follow evidence-based guidelines. Moreover, appropriate guidelines do not exist for surgical site infection. Generic guidelines that cannot possibly take into account differences in procedure type and length are not suitable. For example, it would be devastating if we applied one guideline to the treatment of all cancers, each type requires different mechanisms of treatment. Even when following the best evidence-based medicine, including administration of appropriately selected pre-operative antibiotics and discontinuation of antibiotics within 24 hours post-operatively, certain patients who undergo orthopaedic procedures will still develop a surgical site infection. Risk factors for surgical site infections after skeletal trauma are most strongly determined by nonmodifiable factors such as patient co-morbidities and injury complexity. Therefore, it is important to recognize this level of unavoidability and apply a method of risk adjustment that can adequately encompass the relevant risk factors. We believe that without risk adjustment the system creates a disincentive to treat patients with the co-morbidities listed above. We would strongly recommend that prevalence measures include a risk adjustment component. It would be inequitable to compare facilities such as large academic centers that often see the sickest and most vulnerable patients. Policy should not create an incentive for any provider to deselect sicker patients.

6 Venous Thromboembolism The AAOS suggests that NQF take a cautious, measured approach toward development of venous thromboembolism measures. Even with best practice recommendations from the AAOS or the American College of Clinical Pharmacy (ACCP), the incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) following total knee and hip replacement can at best be reduced but not eliminated. Often the trade-off for lower rates of DVT/PE is more wound complications including surgical site infections. Moreover, there is also recent evidence that some PEs diagnosed in hospitalized patients may prove to be clinically insignificant. Yet treatment of any PE is not without risk. For example, anticoagulation, the current standard of care for all pulmonary emboli, can result in bleeding, and inferior vena cava filters can cause substantial bleeding, and even result in subsequent DVT. Finally, certain patient risk factors, including obesity, history of venous thromboembolism, and cancer, are known to be associated with a higher risk of VTE. Patients with these conditions are at increased risk for VTE even after receiving appropriate, evidence-based, guideline-recommended prophylaxis. Defining VTE as a reasonably preventable HAC would make surgeons and hospitals less likely to offer potentially beneficial, life-altering procedures to patients with these risk factors. The AAOS believes that applying a healthcare-associated condition policy requires analysis and discretion. We urge NQF/MAP to be cautious when selecting specific healthcare-associated conditions. Our current care and payment system is far too disjointed to tackle the concept of attribution with accuracy. Therefore we would encourage NQF/MAP to choose conditions that are immediately or irrefutably attributable to the service being provided. Risk-Adjustment The AAOS supports movement toward developing clinically relevant quality measures which recognize the importance of measuring both process and outcome. We cannot stress enough the importance of risk adjustment when outcome measures are publicly reported and/or used in future value-based purchasing programs. Both of these quality tools rely on accurate, valid, and reliable data to inform stakeholders and improve quality. Without risk adjustment, comparisons are not equitable. Risk adjustment facilitates equitable comparison among providers by accounting for patient s co-morbidities and co-conditions that increase their risk for complications and further treatment. Risk adjustment will significantly vary for acute and chronic conditions and among the individual conditions or procedures. The AAOS, however, urges NQF/MAP to proceed

7 cautiously to ensure accuracy and reliability of the methodologies as well as the quality of data. The AAOS recommends that NQF/MAP capture as many co-morbidities as possible in its risk-adjustment methodologies. Each condition and/or procedure has different associated co-morbidities, co-conditions, and complications. Chronic conditions have associated acute episodes that may be unavoidable and other associated acute episodes that are avoidable. In addition, chronic conditions will have acute episodes that are unrelated to that condition. Accordingly, postacute care and readmissions will vary in their necessity and preventability based on each specific condition and/or procedure and each patient s severity, comorbidities, and treatment plans. The AAOS believes that risk adjustment must adequately account for a patient s unique risk factors. Moreover, the AAOS advocates that high-risk and co-morbid patients not be placed at a disadvantage for access to high quality, effective healthcare. We are concerned that hospitals will incentivize physicians to deselect patients based on their risk factors or co-morbidities. If patient deselecting occurs, tertiary centers will be further inundated with the most complex, high-risk patients. The AAOS urges NQF/MAP to further develop a means for risk adjusting for the wide range variation in patient characteristics prior to fully implementing the policy. The AAOS believes that risk adjustment is necessary to differentiate and account for patient demographics, co-morbidities, severity of illness, and procedure. NQF/MAP should take into account the condition-specific or procedure-specific risk, and though potentially more difficult, should account for the patient-specific risk factors that affect preventability. Conclusion The AAOS appreciates this opportunity to provide input on the report submitted by MAP addressing coordination strategies for HACs and readmissions, and we invite NQF to call on us as a partner and expert in performance and quality

8 measurement in musculoskeletal care. Please contact William R. Martin, III, MD, at (202) or with any questions on the AAOS comments. Sincerely, Daniel J. Berry, MD President American Association of Orthopaedic Surgeons

Measure Title Measure Description Numerator Statement

Measure Title Measure Description Numerator Statement (NQF) Title Description Numerator 122v2 1 0059 Diabetes: Hemoglobin A1c Poor Control N/A 21 0268 Perioperative Care: Selection of Prophylactic Antibiotic First OR Second Generation Cephalosporin Percentage

More information

Patient Optimization Improves Outcomes, Lowers Cost of Care >

Patient Optimization Improves Outcomes, Lowers Cost of Care > Patient Optimization Improves Outcomes, Lowers Cost of Care > Consistent preoperative processes ensure better care for orthopedic patients The demand for primary total joint arthroplasty is projected to

More information

MN Community Measurement Total Knee Replacement Impact and Recommendation Document June 2010

MN Community Measurement Total Knee Replacement Impact and Recommendation Document June 2010 MN Community Measurement Total Knee Replacement Impact and Recommendation Document June 2010 Degree of Impact Relevance to Consumers, Employers and Payers Annually there are over 500,000 total knee replacement

More information

June 25, 2012. Dear Acting Administrator Tavenner,

June 25, 2012. Dear Acting Administrator Tavenner, June 25, 2012 Marilyn B. Tavenner, RN, Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1588-P P.O. Box 8011 Baltimore, MD 21244-1850

More information

DENOMINATOR: The total number of adult patients (age 18 and over) having had non-emergency surgery

DENOMINATOR: The total number of adult patients (age 18 and over) having had non-emergency surgery Measure #358: Patient-centered Surgical Risk Assessment and Communication National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES:

More information

Andy Slavitt AANS/CNS Comments on Proposed IPPS Rule June 16, 2015 Page 2 of 5

Andy Slavitt AANS/CNS Comments on Proposed IPPS Rule June 16, 2015 Page 2 of 5 AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS THOMAS A. MARSHALL, Executive Director 5550 Meadowbrook Drive Rolling Meadows, IL 60008 Phone: 888-566-AANS Fax: 847-378-0600 info@aans.org President H. HUNT

More information

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson,

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson, October 15, 2010 Dr. Nancy Wilson, R.N., M.D., M.P.H. Senior Advisor to the Director Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road Room 3216 Rockville, MD 20850 Re: National Health

More information

February 26, 2016. Dear Mr. Slavitt:

February 26, 2016. Dear Mr. Slavitt: February 26, 2016 Mr. Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services (CMS) Department of Health and Human Services Attention: CMS-3321-NC PO Box 8016 Baltimore, MD 21244 Re:

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

Measure #358: Patient-centered Surgical Risk Assessment and Communication

Measure #358: Patient-centered Surgical Risk Assessment and Communication Measure #358: Patient-centered Surgical Risk Assessment and Communication 2014 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION: Percentage of patients who underwent a non-emergency surgery

More information

December 3, 2010. Dear Administrator Berwick:

December 3, 2010. Dear Administrator Berwick: Donald Berwick, M.D. Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201

More information

April 22, 2013. RE: Advancing Interoperability and Health Information Exchange. Dear Dr. Mostashari:

April 22, 2013. RE: Advancing Interoperability and Health Information Exchange. Dear Dr. Mostashari: April 22, 2013 Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology Department of Health and Human Services Hubert Humphrey Building, Suite 729-D Washington, DC 20201 RE: Advancing

More information

May 7, 2012. Submitted Electronically

May 7, 2012. Submitted Electronically May 7, 2012 Submitted Electronically Secretary Kathleen Sebelius Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2014 edition EHR

More information

OVERALL IMPLEMENTATION CONSIDERATIONS

OVERALL IMPLEMENTATION CONSIDERATIONS Donald Berwick, M.D., M.P.H. Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington,

More information

August 12, 2010. Dear Dr. Berwick:

August 12, 2010. Dear Dr. Berwick: Donald M. Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Room 314G Washington, DC 20201 Dear Dr. Berwick: I am

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

Ref: Hospital Quality Star Ratings on Hospital Compare Methodology of Overall Hospital Quality Star Ratings

Ref: Hospital Quality Star Ratings on Hospital Compare Methodology of Overall Hospital Quality Star Ratings August 17, 2015 Mr. Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence

More information

Improving Hospital Performance

Improving Hospital Performance Improving Hospital Performance Background AHA View Putting patients first ensuring their care is centered on the individual, rooted in best practices and utilizes the latest evidence-based medicine is

More information

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October

More information

NHS outcomes framework and CCG outcomes indicators: Data availability table

NHS outcomes framework and CCG outcomes indicators: Data availability table NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

More information

Using CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital

Using CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital Using CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital Jonathan Sykes MD, CMIO Jacalyn Liebowitz RN, MBA,NEA-BCFACHE VP Care Continuum Allegiance Health - Jackson, MI DISCLAIMER:

More information

XARELTO (rivaroxaban tablets) in Knee and Hip Replacement Surgery

XARELTO (rivaroxaban tablets) in Knee and Hip Replacement Surgery XARELTO (rivaroxaban tablets) in Knee and Hip Replacement Surgery Fast Facts: XARELTO is a novel, once-daily, oral anticoagulant recently approved in the United States for the prevention (prophylaxis)

More information

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Introduction This report outlines the total knee replacement pilot quality results for care

More information

December 3, 2010. Dear Dr. Berwick:

December 3, 2010. Dear Dr. Berwick: December 3, 2010 Donald Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW

More information

Preventing Never Events

Preventing Never Events Preventing Never Events How EBSCO s Evidence-Based, Point-of-Care Reference Tools Can Help The Evolution of Never Events In 2002, the National Quality Forum (NQF) published a report, Serious Reportable

More information

Center for Clinical Standards and Quality /Survey & Certification Group

Center for Clinical Standards and Quality /Survey & Certification Group DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 Center for Clinical Standards and Quality /Survey

More information

September 8, 2015. Dear Acting Administrator Slavitt:

September 8, 2015. Dear Acting Administrator Slavitt: September 8, 2015 Mr. Andrew Slavitt Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Re: CMS-5516-P;

More information

Measures for the Australian health system. Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare

Measures for the Australian health system. Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare Measures for the Australian health system Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare Two sets of indicators The National Safety and Quality Indicators Performance

More information

Deep Vein Thrombosis Treatment Options

Deep Vein Thrombosis Treatment Options Deep Vein Thrombosis Treatment Options Chuck Procuniar, ARNP Florida Orthopaedic Institute Debbi Warren RN CCRC Foundation for Orthopaedic Research and Education Who More than 2 million suffer from venous

More information

September 4, 2012. Submitted Electronically

September 4, 2012. Submitted Electronically September 4, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1589-P P.O. Box 8016 Baltimore, MD 21244-8016

More information

RE: AMIA Comments on Medicare Shared Savings Program: Accountable Care Organizations CMS-1345-P

RE: AMIA Comments on Medicare Shared Savings Program: Accountable Care Organizations CMS-1345-P June 6, 2011 Dr. Donald M. Berwick Administrator Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services P.O. Box 8013 Baltimore, MD 21244-8013 [Submitted electronically

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT

Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Paul Moore, DPh Senior Health Policy Advisor Office of Rural Health Policy Health Resources and Services Administration Department

More information

April 8, 2013. Dear Ms. Tavenner:

April 8, 2013. Dear Ms. Tavenner: April 8, 2013 Marilyn B. Tavenner Acting Administrator and Chief Operating Officer Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence

More information

Blue Distinction Centers for Spine Surgery Program Program Selection Criteria for 2010 Mid-Point Designations

Blue Distinction Centers for Spine Surgery Program Program Selection Criteria for 2010 Mid-Point Designations Blue Distinction Centers for Spine Surgery Program Program Selection Criteria for 200 Mid-Point Designations Evaluation is based primarily on the facility s responses to the Blue Distinction Centers for

More information

01/22/2010 1. Program Objectives. Quality and Poor Care Coordination

01/22/2010 1. Program Objectives. Quality and Poor Care Coordination Building Community Engagement in Indiana Communities: The Conduit to Transforming Healthcare Empowerment 34 th Annual InAHQ Conference on Healthcare Quality The Triple Crown of Healthcare Quality Nancy

More information

Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Revisions to Part B for CY 2016 Proposed Rule

Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Revisions to Part B for CY 2016 Proposed Rule September 8, 2015 Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: Medicare Program; Revisions to Payment Policies Under the Physician

More information

VENOUS THROMBOEMBOLISM (VTE) INFORMATION FOR PATIENTS UNDERGOING SURGERY

VENOUS THROMBOEMBOLISM (VTE) INFORMATION FOR PATIENTS UNDERGOING SURGERY VENOUS THROMBOEMBOLISM (VTE) INFORMATION FOR PATIENTS UNDERGOING SURGERY Information Leaflet Your Health. Our Priority. Page 2 of 5 What is Venous Thromboembolism (VTE)? Venous Thromboembolism (VTE) is

More information

University of Illinois at Chicago College of Pharmacy. Hospital Compliance with Proposed JCAHO Performance Measures for VTE

University of Illinois at Chicago College of Pharmacy. Hospital Compliance with Proposed JCAHO Performance Measures for VTE 1 Hospital Compliance with Proposed JCAHO Performance Measures for VTE Vikrant Vats, PhD Post Doc Research Associate Center of Pharmacoeconomic Research Background/Rationale Venous thromboembolism (VTE)

More information

Cognos Web-based Analytic Tool Overview

Cognos Web-based Analytic Tool Overview Cognos Web-based Analytic Tool Overview Market, Quality and Physician Data Analysis with Drill-thru Feature Mari Tietze, PhD, RN-BC Director, Nursing Research and Informatics DFWHC ERF 2009 1 UB-04 Source

More information

THE 2015 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY

THE 2015 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY THE 2015 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY Since 2002, Qualis Health has presented the annual Awards of Excellence in Healthcare Quality to outstanding organizations in Idaho and

More information

CMS Vision for Quality Measurement and Public Reporting

CMS Vision for Quality Measurement and Public Reporting CMS Vision for Quality Measurement and Public Reporting Annual Policy Conference Federation of American Hospitals Kate Goodrich, M.D., M.H.S. Quality Measurement & Health Assessment Group, Center for Clinical

More information

Early Results of a Marketwide ACO Initiative: The Alternative Quality Contract (AQC)

Early Results of a Marketwide ACO Initiative: The Alternative Quality Contract (AQC) Early Results of a Marketwide ACO Initiative: The Alternative Quality Contract (AQC) Dana Gelb Safran, Sc.D. Senior Vice President Performance Measurement and Improvement 13 July 2011 Twin Goals of Improving

More information

Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs

Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs Debra Ness Co-Chair, Consumer-Purchaser Disclosure Project President, National Partnership for Women & Families David

More information

Medicare Value-Based Purchasing Programs

Medicare Value-Based Purchasing Programs By Jane Hyatt Thorpe and Chris Weiser Background Medicare Value-Based Purchasing Programs To improve the quality of health care delivered to Medicare beneficiaries, the Centers for Medicare and Medicaid

More information

December 5, 2006. Reference File Code: CMS-4119-P. Dear Sir or Madam:

December 5, 2006. Reference File Code: CMS-4119-P. Dear Sir or Madam: Page 1 of 5 1101 Pennsylvania Avenue Suite 600 Washington, DC 20004-2514 202.756.2227 202.756.7506 [fax] www.accp.com Department of Government & Professional Affairs December 5, 2006 Centers for Medicare

More information

Measuring and Assigning Accountability for Healthcare Spending

Measuring and Assigning Accountability for Healthcare Spending Measuring and Assigning Accountability for Healthcare Spending Fair and Effective Ways to Analyze the Drivers of Healthcare Costs and Transition to Value-Based Payment Harold D. Miller CONTENTS EXECUTIVE

More information

A patient's guide. Your clinic's contact details are: Name: Contact number:

A patient's guide. Your clinic's contact details are: Name: Contact number: A patient's guide Your clinic's contact details are: Name: Contact number: Contents 2 Why have I been prescribed Xarelto? 2 What is Xarelto? 3 How do I take Xarelto? 3 What should I do if I miss a dose

More information

RE: CMS Care Episode and Patient Condition Groups. Dear Acting Administrator Slavitt:

RE: CMS Care Episode and Patient Condition Groups. Dear Acting Administrator Slavitt: February 11, 2016 Mr. Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue, SW Washington, DC 20201 RE: CMS Care Episode

More information

DISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION

DISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION DISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION Venous thromboembolism is the most common complication after total hip and total knee arthroplasty. In recent times members of the Australian Orthopaedic

More information

LEARNING WHAT WORKS AND INCREASING KNOWLEDGE

LEARNING WHAT WORKS AND INCREASING KNOWLEDGE About This Series In February 2010, the George Washington University School of Public Health and Health Services, Department of Health Policy released Changing po 2 licy: The Elements for Improving Childhood

More information

Position Statement: The Use of VTED Prophylaxis in Foot and Ankle Surgery

Position Statement: The Use of VTED Prophylaxis in Foot and Ankle Surgery Position Statement: The Use of VTED Prophylaxis in Foot and Ankle Surgery Position Statement There is currently insufficient data for the (AOFAS) to recommend for or against routine VTED prophylaxis for

More information

1900 K St. NW Washington, DC 20006 c/o McKenna Long

1900 K St. NW Washington, DC 20006 c/o McKenna Long 1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:

More information

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications

More information

May 26, 2011. Section 3022 of the Affordable Care Act. Dear Administrator Berwick:

May 26, 2011. Section 3022 of the Affordable Care Act. Dear Administrator Berwick: Donald M. Berwick, MD, MPP Administrator Attention: CMS-1345-P Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 Re: Section 3022 of the Affordable Care Act Dear Administrator Berwick:

More information

For trauma, there are some additional attributes that are unique and complex:

For trauma, there are some additional attributes that are unique and complex: Saving Lives, Reducing Costs of Trauma Care Trauma Center Association of America Model of Value Based Trauma Care to Evaluate, Test and Pilot July 25, 2013 Unique Nature of Trauma Injury and Treatment:

More information

Anticoagulant Safety Survey ISMP Canada

Anticoagulant Safety Survey ISMP Canada Anticoagulant Safety Survey ISMP Canada General Information: Please answer the following questions to help describe your institution Multi-Site: Yes No Hospital Site Type: Acute Chronic Rehabilitation

More information

Objective 1A: Increase the adoption and effective use of health IT products, systems, and services

Objective 1A: Increase the adoption and effective use of health IT products, systems, and services 1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 Phone: 202/789-1890 Fax: 202/789-1899 apicinfo@apic.org www.apic.org February 4, 2015 Karen DeSalvo, MD, MPH, MSc National Coordinator for Health

More information

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative

More information

June 22, 2012. Dear Administrator Tavenner:

June 22, 2012. Dear Administrator Tavenner: Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue

More information

Failure or significant adverse effects to all of the alternatives: Eliquis and Xarelto

Failure or significant adverse effects to all of the alternatives: Eliquis and Xarelto This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics

More information

December 3, 2010. Donald M. Berwick, M.D. Administrator Centers for Medicare and Medicaid Services Posted to Regulations.gov. File code CMS-1345-NC

December 3, 2010. Donald M. Berwick, M.D. Administrator Centers for Medicare and Medicaid Services Posted to Regulations.gov. File code CMS-1345-NC December 3, 2010 Donald M. Berwick, M.D. Administrator Centers for Medicare and Medicaid Services Posted to Regulations.gov File code CMS-1345-NC Dear Dr. Berwick: The American Urological Association (AUA),

More information

2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions

2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions 2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions The 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) was published in the Federal Register on July

More information

U.S. Department of Health & Human Services May 7, 2014. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings

U.S. Department of Health & Human Services May 7, 2014. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings U.S. Department of Health & Human Services May 7, 2014 New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings The data in this report shows a substantial nine percent

More information

Accountable Care Organization Framework for Pharmaceuticals

Accountable Care Organization Framework for Pharmaceuticals Accountable Care Organization Framework for Pharmaceuticals Speakers Eleanor M. Perfetto, PhD, MS Senior Director, Reimbursement & Regulatory Affairs, Federal Government Relations Pfizer Inc. Robert W.

More information

Clinical Outcomes and Home Infusion A Way Forward Connie Sullivan, RPh demand side strategy References: National Business Coalition on Health

Clinical Outcomes and Home Infusion A Way Forward Connie Sullivan, RPh demand side strategy References: National Business Coalition on Health Clinical Outcomes and Home Infusion A Way Forward Connie Sullivan, RPh Senior Director Education and Data, NHIA Vice President of Research, NHIF Session Objectives Define value based purchasing, and describe

More information

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit

More information

Value-Based Purchasing

Value-Based Purchasing Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based

More information

January 3, 2012. RE: Comments submitted at http://www.regulations.gov.

January 3, 2012. RE: Comments submitted at http://www.regulations.gov. January 3, 2012 RE: Comments submitted at http://www.regulations.gov. Marilyn Tavenner, Acting Administrator U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Attention:

More information

Section C Implement One (1) Clinical Decision Support Rule

Section C Implement One (1) Clinical Decision Support Rule Office of the National Coordinator for Health Information Technology c/o Joshua Seidman Mary Switzer Building 330 C Street, SW, Suite 1200 Washington, DC 20201 Dear Mr. Seidman: On behalf of the American

More information

Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com. News Release. Not intended for U.S. and UK Media

Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com. News Release. Not intended for U.S. and UK Media News Release Not intended for U.S. and UK Media Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com Bayer Forms Collaboration with Academic and Governmental Institutions for Rivaroxaban

More information

Request for Feedback on the CMS Quality Strategy: 2013 Beyond

Request for Feedback on the CMS Quality Strategy: 2013 Beyond Ms. Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-1850 Request for Feedback on the CMS Quality

More information

Advanced Issues in Peri-Operative VTE Prevention

Advanced Issues in Peri-Operative VTE Prevention Advanced Issues in Peri-Operative VTE Prevention Michael-Anthony (M-A) Williams, M.D. Consultant Physician Centura Medical Consultants September 27th, 2012 Main Topics 1. The perils of the early mover-

More information

National Provider Call: Hospital Value-Based Purchasing (VBP) Program

National Provider Call: Hospital Value-Based Purchasing (VBP) Program National Provider Call: Hospital Value-Based Purchasing (VBP) Program Fiscal Year 2016 Overview for Beneficiaries, Providers and Stakeholders Cindy Tourison, MSHI Lead, Hospital Inpatient Quality Reporting

More information

DATE: 06 May 2013 CONTEXT AND POLICY ISSUES

DATE: 06 May 2013 CONTEXT AND POLICY ISSUES TITLE: Low Molecular Weight Heparins versus New Oral Anticoagulants for Long-Term Thrombosis Prophylaxis and Long-Term Treatment of DVT and PE: A Review of the Clinical and Cost-Effectiveness DATE: 06

More information

what value-based purchasing means to your hospital

what value-based purchasing means to your hospital Paul Shoemaker what value-based purchasing means to your hospital CMS has devised an intricate way to measure a hospital s quality of care to determine whether the hospital qualifies for incentive payments

More information

Medicare Program; Hospital Inpatient Prospective Payment System Proposed Rule for FY 2016 (CMS-1632-P)

Medicare Program; Hospital Inpatient Prospective Payment System Proposed Rule for FY 2016 (CMS-1632-P) June 15, 2015 VIA ELECTRONIC FILING Mr. Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1632-P Mail Stop C4-26-05 7500

More information

Service Specification Template Department of Health, updated June 2015

Service Specification Template Department of Health, updated June 2015 Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st

More information

New Oral Anticoagulants. How safe are they outside the trials?

New Oral Anticoagulants. How safe are they outside the trials? New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants

More information

Dear Honorable Members of the Health information Technology (HIT) Policy Committee:

Dear Honorable Members of the Health information Technology (HIT) Policy Committee: Office of the National Coordinator for Health Information Technology 200 Independence Avenue, S.W. Suite 729D Washington, D.C. 20201 Attention: HIT Policy Committee Meaningful Use Comments RE: DEFINITION

More information

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,

More information

February 29, 2016. Andy Slavitt, Acting Administrator Centers for Medicare & Medicaid Services 200 Independence Ave., SW Washington, DC 20201

February 29, 2016. Andy Slavitt, Acting Administrator Centers for Medicare & Medicaid Services 200 Independence Ave., SW Washington, DC 20201 Andy Slavitt, Acting Administrator Centers for Medicare & Medicaid Services 200 Independence Ave., SW Washington, DC 20201 Dear Acting Administrator Slavitt: On behalf of the American Academy of Family

More information

Cancer Treatment Planning: A Means to Deliver Quality, Patient-Centered Care

Cancer Treatment Planning: A Means to Deliver Quality, Patient-Centered Care Cancer Treatment Planning: A Means to Deliver Quality, Patient-Centered Care Patricia A. Ganz, M.D. Jonsson Comprehensive Cancer Center UCLA Schools of Medicine & Public Health Overview of Presentation

More information

HOSPITAL INPATIENT AND OUTPATIENT UPDATE RECOMMENDATIONS

HOSPITAL INPATIENT AND OUTPATIENT UPDATE RECOMMENDATIONS Glenn M. Hackbarth, J.D. 64275 Hunnell Road Bend, OR 97701 Dear Mr.Hackbarth: The Medicare Payment Advisory Commission (MedPAC) will vote next week on payment recommendations for fiscal year (FY) 2014.

More information

INFORMED CONSENT FOR SLEEVE GASTRECTOMY

INFORMED CONSENT FOR SLEEVE GASTRECTOMY INFORMED CONSENT FOR SLEEVE GASTRECTOMY This informed-consent document has been prepared to help inform you about your Sleeve Gastrectomy including the risks and benefits, as well as alternative treatments.

More information

Catherine Dodd, RN, PhD Director, Health Service System

Catherine Dodd, RN, PhD Director, Health Service System Catherine Dodd, RN, PhD Director, Joint Labor Management Wellness Committee Presentation January 2013 Total Medical Premium Costs 2011-12 Kaiser $282.6M Blue Shield $275.6M City Plan $65.5M Kaiser and

More information

Data Analysis Project Summary

Data Analysis Project Summary of Introduction The notion that adverse patient safety events result in excess costs is not a new concept. However, more research is needed on the actual costs of different types of adverse events at an

More information

Deep vein thrombosis and being in hospital

Deep vein thrombosis and being in hospital Deep vein thrombosis and being in hospital Exceptional healthcare, personally delivered Deep vein thrombosis is a well defined medical condition that can develop when someone is ill or having an operation.

More information

Quality Standards Programme NICE cost impact and commissioning assessment: quality standard for venous thromboembolism (VTE) prevention Introduction

Quality Standards Programme NICE cost impact and commissioning assessment: quality standard for venous thromboembolism (VTE) prevention Introduction Quality Standards Programme NICE cost impact and commissioning assessment: quality standard for venous thromboembolism (VTE) prevention Introduction NICE quality standards contain a set of quality statements

More information

NOAC Reversal Agent Think Tank Follow-Up: Post Approval Safety & Effectiveness Pharmacoepidemiologic Approaches and Big Data

NOAC Reversal Agent Think Tank Follow-Up: Post Approval Safety & Effectiveness Pharmacoepidemiologic Approaches and Big Data NOAC Reversal Agent Think Tank Follow-Up: Post Approval Safety & Effectiveness Pharmacoepidemiologic Approaches and Big Data Nancy Dreyer, PhD Chief of Scientific Affairs Copyright 2014 Quintiles FDA Feb

More information

September 8, 2015. Dear Mr. Slavitt,

September 8, 2015. Dear Mr. Slavitt, September 8, 2015 Mr. Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence

More information

National Strategy for Quality Improvement in Health Care

National Strategy for Quality Improvement in Health Care 2012 Annual Progress Report to Congress National Strategy for Quality Improvement in Health Care Submitted by the U.S. Department of Health and Human Services April 2012 Corrected August 2012 and May 2014

More information

December 15, Dear Acting Administrator Slavitt:

December 15, Dear Acting Administrator Slavitt: December 15, 2015 Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 1850 Via Regulations.gov

More information

Trust Guideline for Thromboprophylaxis in Trauma and Orthopaedic Inpatients

Trust Guideline for Thromboprophylaxis in Trauma and Orthopaedic Inpatients A clinical guideline recommended for use In: By: For: Key words: Department of Orthopaedics, NNUHT Medical staff Trauma & Orthopaedic Inpatients Deep vein thrombosis, Thromboprophylaxis, Orthopaedic Surgery

More information

What Providers Need To Know Before Adopting Bundling Payments

What Providers Need To Know Before Adopting Bundling Payments What Providers Need To Know Before Adopting Bundling Payments Dan Mirakhor Master of Health Administration University of Southern California Dan Mirakhor is a Master of Health Administration student at

More information

Getting to value in high-value health care

Getting to value in high-value health care + Getting to value in high-value health care Ashish K. Jha, MD, MPH December 4 th, 2015 @ashishkjha + We have a value problem 1 + Value= Quality Costs + Quality is suboptimal 1 in 4 seniors injured during

More information

Published 2011 by the American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018. AAOS Clinical Practice Guidelines Unit

Published 2011 by the American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018. AAOS Clinical Practice Guidelines Unit Volume 4. AAOS Clinical Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty Comparison with Other Guidelines Disclaimer This clinical guideline

More information

Responses to Questions on Protection of Medicare Beneficiaries

Responses to Questions on Protection of Medicare Beneficiaries www.alz.org Public Policy Office 202 393 7737 p 1212 New York Avenue, NW 866 865 0270 f Suite 800 Washington, DC 20005-6105 The Honorable Max Baucus Chairman Senate Finance Committee The Honorable Orrin

More information