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Mountain-Pacific Quality Health Orientation & 10thSOW Update
Shanelle Van DykeData Analyst/Quality Data Reporting Project Lead
Who We Are
Mountain-Pacific is a…o Nonprofito Physician-sponsoredo Quality Improvement Organization for:
o Montana
o Wyoming
o Hawaii
o Alaska
Our funding comes from…o The Centers for Medicare & Medicaid Serviceso State contractso Private contracts
What We Doo We work with hospitals, nursing homes, home health agencies, and physicians’ offices.
o We provide training, education, and consultation on quality improvement techniques to providers of health care services.
o We provide utilization review and authorization services to ensure health care services and equipment are medically necessary and appropriate.
o We provide case management for high-cost or complex cases.
o We share drug therapy information with providers and health care plans so inappropriate or unnecessary drug usage can be avoided.
o We provide peer review of selected medical records for utilization and quality purposes.
Quality Improvement Techniqueso Training and Education
o Robust process improvement
o Patient safety, human factors, and error reporting
o Root cause analysis (RCA), failure effect mode analysis (FMEA), and
other improvement methodologies
o Professional Serviceso Quality and safety plan review or development
o Core measure expertise
o Quality improvement consulting
o Performance analysis and process redesign
o Meeting, project, or focus group facilitation
o Control and prevention of health care-associated conditions and
infections
Our Missiono To improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.
o In accordance with recent quality efforts, Mountain-Pacific strives to improve safety, timeliness, and equity of person-centered care.
o Ensure that Medicare services are reasonable and medically necessary.
o Promote effective, efficient, and economical delivery of health care services to ensure the quality of services being provided.
Our Vision“The best quality health care is provided to every patient we serve,
every time…”
You’re in the business of providing quality care, but with ever-increasing demands on time and resources can you be sure you’re meeting the needs of your patients, residents and clients without compromising quality?
For more than 30 years, the staff at Mountain-Pacific has assisted health care providers in ensuring the delivery of the right care, at the right time, every time.
We continue in our commitment to helping you succeed in your efforts by offering a variety of services that will allow you to focus on what is most import to you…
Providing Quality Care
10th SOW Contract Purpose
Three Broad Aims:o Better health careo Better health for people and communitieso Affordable care through lowering cost by improvement
Six Priorities:o Making care safero Promoting effective coordination of careo Assuring care is person and family-centeredo Promoting the best possible prevention and treatment of the leading
causes of mortality, starting with cardiovascular diseaseo Helping communities support better healtho Making care more affordable for individuals, families, employers, and
governments by reducing the costs of care through continual improvement.
10th SOW Drivers and Aims
Strategic Aims“What will be done”
Beneficiary-Centered CareoCase ReviewoPatient and Family Engagement
Improve Individual Patient Careo Patient Safety–Reduce HACs by 40%oImproving Quality through Value- Based Purchasing
Integrate Care for PopulationsoCare Transitions that Reduce Readmissions by 20%oUsing Data to Drive Dramatic Improvement in Communities
Improve Health for Populations and CommunitiesoPrevention through screening and immunizationsoPrevention in Cardiovascular Disease
Other Rapid-Cycle Projects
Drivers of Change“How the work will be done”
Learning and Action Networks Breakthrough Collaboratives Patient Engagement and Stories Campaigns Technical Assistance Learning Laboratories
Focused Technical Assistance On-site Visits Intensive Consultation Distribution of Resources
Care Reinvention through Innovation Spread
Identification of Stakeholders Spread Strategies Multi-media management
10th SOW Tasks: Beneficiary and Family Centered Care
What is Case Review?Comprehensive review of information from multiple data sources to analyze the care and services provided to the beneficiary during an episode of care.
What are the types of case reviews?• Quality of Care Reviews
• beneficiary initiated quality of care concerns, other persons or entities, referral of cases for quality of care review
• Emergency Medical Treatment and Labor Act (EMTALA) Reviews• Potential Anti-Dumping Cases
• Reviews of Beneficiary Requests of Provider Discharges/Service Terminations and Denials of Hospital Admissions
• Higher-Weighted Diagnosis-Related Group (HWDRG) Reviews
10th SOW Tasks: Beneficiary and Family Centered Care
Patient and Family Engagement Campaign As directed by CMS, the QIO must develop and implement a Patient and Family Engagement Campaign that supports the DHHS and CMS goals of person-centeredness and family engagement and promotes statewide quality improvement that aligns with the National Quality Strategy.
Who is the target audience?All Medicare beneficiaries and their representatives, Non-Medicare beneficiaries for Emergency Medical Treatment and Active labor Act (EMTALA)
10th SOW Tasks: Integrating Care for Population & Communities
Improving Care Transitions Leading to Reduction of Readmissionso Improve the quality of care for Medicare beneficiaries as they transition between
providers
o Reduce readmissions following hospitalization by 20%
o Yield sustainable and replicable strategies to achieve high-value health care
Using Data to Drive Dramatic Improvement in Communitieso Identify communities with opportunities for improvement
o Ensure communitywide adoption of improved practices.
o Conduct rapid-cycle community-based improvement initiatives and learning
activities
o Develop a statewide community health care indicator map
o Scan horizon for indices of patient care, population health, and per capita cost
10th SOW Tasks: Improving Health for Populations & Communities
Promotion of Immunizations and Screeningso Improving 4 Preventive Services:
o Flu immunizations
o Pneumococcal vaccinations
o Colorectal screening
o Breast cancer screening
Cardiovascular Health Campaigno Improving 4 Cardiac Health Measures:
o Low-dose aspirin therapy
o Blood pressure control
o Cholesterol control
o Tobacco cessation
10th SOW Tasks: Improving Individual Patient Care
Reducing Adverse Drug Events
o Implement PDSA cycles for improvement o Develop and implement safe medication systemso Develop patient education toolso Tracking compliance of beneficiarieso Data managing
o Create a registry to track and monitor beneficiaries health status is a part of
managing the data
o Track all adverse and preventable adverse drug events that are ongoing among
community teams
10th SOW Tasks: Improving Individual Patient Care Quality Data Reporting: Promote and support hospital Inpatient Quality
Reporting (IQR) program participation and Hospital Outpatient Quality
Reporting (OQR) program participation from both CAH and PPS facilities.
What’s been added?o Outpatient Data Collection and Reportingo Support of CAH Data Collection and Reporting for Inpatient and Outpatiento Statewide Quality Improvement:
o Focuses on clinical topics included in CMS Hospital Quality Reporting programs
and patient experience of care
o Statewide assistance to hospital inpatient and outpatient depts.
o Inpatient - Includes quality of care processes (SCIP, AMI, HF, and PN) and
patient experience of care (inpatient)
o Outpatient – Includes quality of care processes (ED–AMI/Chest Pain, SCIP)
o Evaluates attainment and improvement
o More clinical topic areas in inpatient setting
Value-Based Purchasing (VBP)
Per the provisions in the Hospital Value-Based Purchasing Program (VBP) final rule, payments will be tied to performance on quality measures, related to common and high‐cost conditions, such as cardiac, surgical and pneumonia care.
Next steps… • By March 23, 2012 – Secretary must establish 2 separate, three-year VBP demonstration programs:
• one for CAHs, and one for small hospitals with insufficient numbers of measures and/or cases;
• these demonstrations programs are currently underway;• the programs are to culminate in a report and recommendations for permanent VBP programs.
• By October 1, 2012 (FY13) – hospitals will be paid based on the quality performance standards
Why Should You Report? Getting on board now with Inpatient and/or Outpatient Reporting (IQR/OQR) will help you and your team:
• Improve patient care across broad populations, both inpatient and outpatient• Implement/sustain an informed quality improvement program• Improve hospital services, administration and operations• Allow for your hospital’s comparison to benchmarks that will be released in August of this year
• What gets measured gets managed• Allow for your hospital to improve its’ performance now by putting systems in place early, so your hospital’s payment will not be negatively affected.
• This will help to engage your staff in important quality improvement initiatives.
Please Note: If your facility is already on board with Inpatient reporting, the transition to Outpatient reporting is very minimal. The abstraction time is much, much less and the Outpatient measures are more beneficial to a CAH setting.
10th SOW Tasks: Improving Individual Patient Care
Hospitals
o Support hospitals in the reduction of CLABSI, CAUTI, SSIs, and CDI
o Ensure hospital reporting of CLABSI and CAUTI and eventually CDI to NHSN
o Provide technical assistance to develop a system of tracking and monitoring hand
hygiene
o Administer reduction activities and learning networks
o Obtain commitment letters signed by at least two members of hospital leadership,
including a Board member
Nursing Home
o Support reduction of healthcare-acquired conditions by 40% in nursing homes
o Phase 1 - Pressure ulcers and physical restraints
o Phase 2 – CAUTI, falls, staff turnover (through use of consistent
assignment)
o Support, lead, and convene a statewide Learning and Action Network to reduce
healthcare-acquired conditions by improving nursing home quality of care
10th SOW Tasks: Improving Individual Patient Care
Specific Requirements- Reducing Healthcare-Associated Infections
QIO shall recruit CLABSI and/or CAUTI participants:
o From ICU and non-ICU hospitals
o Who are already reporting HAI data to NHSN
o Who can be data ready with at least 6 months of baseline data for CLABSI and/or
CAUTI no later than October 31, 2011.
o Who have a CLABSI rate at or above 1.5 per 1000 central line days
QIO shall train CLABSI and/or CAUTI participants on CUSP by January 31, 2012
o Provide technical assistance that leads to a system of tracking and monitoring for
hand hygiene
o Implement effective trigger tool that tracks and prompts providers to remove
unnecessary catheters and central lines
o Assist with family/patient education on prevention of HAIs
10th SOW Tasks: Learning and Action Networks
What are Learning and Action Networks?
Mechanisms by which large-scale improvement around a given aim is fostered, studied,
adapted and rapidly spread regardless of the change methodology, tools or time-bounded
initiative that is used to achieve the aim.
o Consciously manage knowledge as a valuable resource
o Engage leaders around an action-based agenda
o Create opportunities for in-depth learning and problem solving
o Accept all offers of support seeking to harness the will of interested parties
o Transparent, flexible, interchangeable and purposeful
QUESTIONS ?
This material was developed by Mountain-Pacific Quality Health, the Medicare quality improvement organization for Montana, Wyoming, Hawaii and Alaska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy.
9thSOW-MPQHF-Gen-11-01
Contacts:
Shanelle Van Dyke Data Analyst Quality Data Reporting Project Manager 406-457-5896 (work) [email protected]
Christy Fuller MT Office Director 406-457-5829 (work) [email protected]
Ericka Alm Quality Data Reporting Specialist
406-457-5811 (work)[email protected]
Mary DanelsonQuality Improvement Coordinator406-457-5829 (work)[email protected]
Gayla Brown Quality Improvement Coordinator
406-457- (work)[email protected]
Colleen Roylance Quality Improvement Coordinator 406-457-5874 (work) [email protected]
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